Management of invasive candidaemia is challenging, more emphasis
is needed regarding review and follow up of individual cases to
establish delivering appropriate management and care.
Candidaemia in paediatrics
a 12 year retrospective analysis to
examine changes in species distribution and antifungal
, Kathleen Harvey-Wood
, Carol Lucas
Glasgow and Clyde South Sector Microbiology,
NHS Greater Glasgow
Bloodstream infections (BSI) caused by Candida species
are responsible for significant morbidity and mortality in hospitalised
children. Identification of Candida to species level can predict
antifungal susceptibilities, and the determination of Minimum
Inhibitory Concentrations (MICs) to antifungal agents informs thera-
We performed comparative analysis of two 6
year periods (2004-end 2009, 2010-end 2015) to calculate if there was
statistically significant variation in prevalent species. Antifungal
susceptibilities were examined to determine changes that would
Laboratory records of all cases of candidaemia were
examined retrospectively using CDC/NHSN 2016 surveillance defini-
tions of BSI. Broth microdilution (Sensititre
YeastOne) was used to
determine MICs to a range of antifungal agents.
There was a decrease in overall number of isolates, episodes
and patients in the second timeframe, but epidemiological shift with
. Calculation of p-values for species
predominance did not reveal significance, possibly influenced by small
sample numbers. All isolates from both timeframes were susceptible
to amphotericin B. For fluconazole susceptibility, in the earlier
timeframe 6.8% isolates were sensitive dose-dependent, in the later
timeframe 4% were sensitive dose-dependent and 10.4% were
resistant. All isolates were sensitive to voriconazole and caspofungin
in the first timeframe, but 6% had reduced susceptibility to
voriconazole and 2% to caspofungin in the later group.
Discussion and/or Conclusion(s):
remains the preva-
lent species in this paediatric population. Of note is the increase in
incidence of reduced susceptibility to certain antifungal agents.
Continued vigilance is required to detect further changes in suscep-
tibility and species distribution.
Voriconazole therapeutic drug monitoring (TDM)
Aiden Joseph Plant, Hannah Burnett, Cressida Auckland.
Royal Devon &
Exeter NHS Foundation Trust
Voriconazole is a triazole, broad-spectrum antifungal;
active against yeasts, dimorphic and filamentous fungi and lacking
activity against zygomycetes. Non-linear pharmacokinetics, cyto-
chrome P450 polymorphisms and oral bioavailability ranging from
60% to 86% in children and the sick explains extensive variation in
serum voriconazole concentrations. Therapeutic drug monitoring
(TDM) is recommended for both prophylaxis and treatment.
Assuming this as an auditable standard, we
describe a Trust-wide assessment of voriconazole TDM.
Pharmacy records of voriconazole dispensed from June
2015 to June 2016 were retrospectively reviewed. Adults and children
receiving voriconazole for more than two-weeks as prophylaxis or
treatment were included. Patient demographics, treatment indication
and TDM results were recovered from the Trust
Eight patients were identified, with a median age of 51 years
69) and no gender difference. Three patients received
voriconazole prophylaxis during treatment for haematological malig-
nancy. The remaining five received treatment: three had invasive
aspergillosis, one had allergic bronchopulmonary aspergillosis and
one had endophthalmitis. There was one episode of voriconazole TDM
in these eight cases.
Discussion and/or Conclusion(s):
There is insufficient voriconazole
TDM in our patient population. Better outcomes are demonstrable in
patients who receive voriconazole TDM versus no TDM, and supra-
therapeutic troughs have been associatedwith toxicity. It is crucial that
patients receiving either prophylaxis or treatment with voriconazole
In response to this audit principles of good antimicrobial stewardship
(speciality-specific seminars and clinical practice guidelines) are being
introduced, with subsequent prospective audit and feedback to
improve utilisation of TDM in voriconazole use.
The use of (1
-D-Glucan testing in bronchoalveolar lavage
samples in the diagnosis of invasive fungal disease and
Felicia Lim, Nelun Perera.
University Hospitals of Leicester NHS Trust
-D-Glucan (BDG) and Galactomannan (GM) are
both biomarker tests that have been used in recent years to aid the
diagnosis of Invasive Fungal Disease (IFD).
We conducted a service evaluation to look at the
utility of testing BDG compared to GM in BAL samples to aid the
diagnosis of IFD.
BAL samples from patients with haematological malig-
nancies and bone marrow transplantation were tested retrospectively
for BDG using the Fungitell
assay. Comparison was made between
BDG and GM from BAL samples. The Computerised Tomography of the
chest (CT chest) were reviewed for the same patients and were
classified into probable and possible IFD based on the revised 2008
European Organization for Research and Treatment of Cancer/
Mycoses Study Group (EORTC/MSG) definitions. BDG from BAL were
also compared with results of
A total of 24 BAL samples had both biomarkers tested. Both
BDG and GM had similar sensitivity in the diagnosis of probable/
possible IFD (27.3% vs 25.0%). However BDG had a much lower
specificity compared to GM (53.9% vs 84.7%).
BDG in BAL showed a good negative predictive value for
DNA PCR positivity (NPV 92.9%, sensitivity 85.7%, specificity
Discussion and/or Conclusion(s):
BDG testing in BAL was not shown
to be of clinical utility in the diagnosis of IFD. However, it may be a
useful assay for ruling-out the diagnosis of pneumocystis pneumonia
in this patient population.
Candida epidemiology and antifungal resistance: a ten year review
of candida blood stream infections in University Hospitals of
, Helen Kirk-Granger
, Armin Ghanbari
Clinical Microbiology University Hospitals of Leicester
NHS Trust Level 5 Sandringham Building,
University Hospitals Leicester
Candida blood stream infection (CBSI) is one of the com-
monest causes of bloodstream infections among hospitalised patients
and is associatedwith highmorbidity andmortality. The incidence and
antifungal resistance varies between countries and units.
To review the epidemiology and antifungal
resistance of CBSI in University Hospitals of Leicester (UHL) over a
period of 10 years (2005
Laboratory and clinical data of CBSI between 2005 and
2015 were reviewed retrospectively for patient demographics, species
and antifungal resistance.
A total of 337 patients with 337 episodes of CBSI were
identified (mean 33.7 episodes of CBSI/year). 87% of the episodes were
in adults with almost equal number of episodes among the two
genders (170 F, 167 M). Majority of the episodes were from patients in
Abstracts of FIS/HIS 2016
Poster Presentations / Journal of Hospital Infection 94S1 (2016) S24