**6. References**


form such ecosystems. In that case, studies like the recent one can only give evidence of

Another set of microsatellite markers is likely to give more information about those strains which are able to form biofilms on indwelling devices or about the epidemiological behavior

This work was partly funded by the Hygiene Fund of the Medical University of Graz. This work was performed in the TTIW-cooperation framework of Wetsus, centre of excellence for sustainable water technology (www.wetsus.nl). Wetsus is funded by the Dutch Ministry of Economic Affairs. The authors like to thank the participants of the research theme "DNA

Applied Biosystems. 2005. *GeneMapper® Software Version 4.0 Microsatellite Analysis Getting* 

Beretta, S.; Fulgencio, J.P.; Enache-Angoulvant, A.; Bernard, C.; El Metaoua, S., Ancelle, T.;

Bernhardt, H. (1998). Fungi in the intestine - normal flora or pathogens? *Zeitschrift für ärztliche Fortbildung und Qualitätssicherung*, Vol.92, No.3, pp. 154-156 Botterel, F.; Desterke, C.; Costa, C. & Bretagne, S. (2001). Analysis of microsatellite markers

David, A.; Risitano, D.C.; Mazzeo, G.; Sinardi, L.; Venuti, F.S. & Sinardi, A.U. (2005).

Donlan, R.M. (2001). Biofilm formation: a clinically relevant microbiological process. *Clinical* 

Donskey C.J. (2004). The role of the intestinal tract as a reservoir and source for

El-Azizi, M.A.; Starks, S.E & Khardori, N. (2004). Interactions of Candida albicans with other

Eloy, O.; Marque, S.; Botterel, F.; Stephan, F.; Costa, J.M.; Lasserre, V. & Bretagne, S. (2006).

Fan, S.R.; Liao, Q.P.; Li, J.; Liu, X.P.; Liu, Z.H. & Bai, F.Y. (2007). Genotype distribution of

*Infectious Diseases*, Vol.33, No.8, pp. 1387-1392, ISSN 1058-4838

*Infectious Diseases*, Vol.13, No.6, pp. 162, ISSN 1471-2334

Denis, M. & Hennequin, C. (2006). Application of microsatellite typing for the investigation of a cluster of cases of Candida albicans candidaemia. *Clinical* 

of Candida albicans used for rapid typing. *Journal of Clinical Microbiology*, Vol.39,

Central venous catheters and infections. *Minerva Anestesiologica*, Vol.71, No.9, pp.

transmission of nosocomial pathogens *Clinical Infectious Diseases*, Vol.39, No.2, pp.

Candida spp. and bacteria in the biofilms. *Journal of Applied Microbiology*, Vol.96,

Uniform distribution of three Candida albicans microsatellite markers in two French ICU populations supports a lack of nosocomial cross-contamination. *BMC* 

Candida albicans strains associated with different conditions of vulvovaginal

based detection technologies" for the fruitful discussions and their financial support.

*Microbiology and Infection*, Vol.12, No.7, pp. 674-676, ISSN 1198-743X

*Started Guide*. Applied Biosystems, Foster City, California.

epidemiological behavior of the species investigated.

No.11, pp. 4076-4081, ISSN 0095-1137

No.5, pp. 1067-1073, ISSN 1365-2672

561-564, ISSN 0375-9393

219-226, ISSN 1058-4838

of clinically important strains.

**5. Acknowledgment** 

**6. References** 

candidiasis, as revealed by microsatellite typing. *Sexually Transmitted Infections*, Vol.84, No.2, pp. 103-106, ISSN 1472-3263


**2** 

*Spain* 

**Epidemiology of Bloodstream** *Candida* **spp.** 

*Candida* bloodstream infections (BSI) have become a major healthcare problem, specially in tertiary- care hospitals worldwide (Al-Jasser & Elkhizzi, 2004, Almirante et al., 2005, Alonso-Valle et al., 2003, Atunes et al., 2004 Asmundsdottir et al., 2002, Costa et al., 2000, Fraser et al., 1992, Garbino et al., 2002, Luzzati et al. 2000, Marchetti et al., 2004, Pappas et al., 2003, Viudes et al., 2002). Several risk factor identified among patients hospitalized for long periods such as the exposition to broad spectrum antimicrobial and/or immunosuppressive chemotherapy, parenteral nutrition, and invasive medical procedures have contributed to this fact (Blumberg et al., 2001, Fraser et al., 1992). Despite some improvements in fungal BSI diagnosis during last years, candidemia diagnosis remains difficult. Besides, following the data appeared in the classical study from Berenguer and colleagues, only 50% of patients with disseminated candidiasis will have positive blood cultures and even fewer will have an antemortem diagnosis (15% to 40%) (Berenguer et al., 1993). Therefore, invasive candidemia is not easy to diagnose, has an expensive treatment and finally is a serious, often life-

Although the incidence of candidemia has increased steadily among hospitalized patients during the eighties and nineties, recent series suggest that This increase has stabilized, but with great variations between different geographical locations with similar socio-economical development even in the same continent. For instance, in The Netherlands an increasing incidence of candidemia has been reported during the period between eighties and nineties (Voss et al., 1996) but on the other hand, in a neighbouring country such as Switzerland the incidence of *Candida* BSI infections remained unchanged during the same period (Marchetti et al., 2004). Therefore, it seems that there are some differences in the epidemiology of

Besides, in recent years, a trend towards increasing resistance to both traditional and more recently introduced antifungal agents has been observed amongst invasive *Candida* infections, underscoring the need for continuous surveillance to monitor trends in incidence,

threatening infection (Girmenia et al., 1996, Messer et al., 2009).

species distribution, and antifungal drug susceptibility profiles.

candidemia between different countries.

**1. Introduction** 

**Infections Observed During a Surveillance** 

**Study Conducted in Spain** 

R. Cisterna, G. Ezpeleta and O. Tellería

*Basurto Hospital, Avenida Montevideo – Bilbao* 

*Clinical Microbiology and Infection Control Department* 

