BIBLE PAPER 26 AUG 2015 CANDIDA GLABRATA ESOPHAGITIS: ARE WE SEEING THE EMERGENCE OF A NEW AZOLE-RESISTANT PATHOGEN? WILSON A, DELPORT J, PONICH T. INT J MICROBIOL 2014;

BACKGROUND Candida are common pathogens in esophagitis Candida albicans is the most common cause of fungal esophagitis Non-albicans species are increasingly diagnosed A proportion of the C. glabrata-strains are azole-resistant

Aims of this study: Incidence of Candida glabrata esophagitis Risk factors that may predispose to this condition

METHODS Single centre, retrospective chart review conducted in London, Ontario, Canada Adult gastroenterology patient charts were collected from January 2009 to July 2011 Any charts of patients with esophagitis with a positive fungal culture were reviewed for the species of Candida and the presence of risk factors for esophageal candidiasis

RESULTS 1701 charts met the inclusion criteria (esophageal biopsies and brushings) 55 patients (3.2%) had endoscopic findings 37 patients (2.2%) were diagnosed with candida esophagitis by microbiologic culture

Distribution of candida species: C. albicans: 27 subjects, 73% C. glabrata: 9 subjects, 24.3% C. tropicalis: 1 subject, 2.7% 6 patients with mixed infections

Risk factors: C. glabrata patients were slightly younger than C. albicans patients More frequent in inpatients (C. albicans: equally distributed) Risk factors did not vary significantly

Azole-susceptibility: Azole-susceptibility patterns were available for 20 patients with C. glabrata 3/20 cases were resistant, 1/20 was susceptible, and 16/20 cases were susceptible-dose-dependent

DISCUSSION Infection with C. glabrata is more common than previously quoted A high degree of suspicion is important especially in patients admitted to the hospital Esophageal brushings and cultures are important Empirical treatment with fluconazol may not be adequate for C. glabrata infections C. glabrata infections should be treated with a echinocandin, unless azole-susceptibility has been demonstrated