Oropharyngeal Candidiasis in Palliative Care Patients in Denmark

Oropharyngeal candidiasis (OPC) is a significant cause of morbidity, especially among patients with advanced cancer. The incidence and significance of yeast carriage and OPC in the palliative care setting in Denmark is unknown. The best diagnostic strategy and treatment regimen has to be defined.

This study evaluated the clinical and microbiological incidence of yeast carriage/OPC and assessed available diagnostic procedures-culture and microscopy. The distribution of Candida species and fluconazole susceptibility was determined.

Terminal care patients admitted to Hospice Sjaelland (Denmark) March to June 2012 were included. Patients were evaluated for clinical OPC and a questionnaire including previous antifungal treatment was obtained. Paired samples from the buccal mucosa and the tongue were sent to microscopy and culture. In total, 105 microscopy slides and 105 cultures from 54 patients were included, yielding 71 Candida isolates. At admission, 22% were in fluconazole treatment and 56% had received an antifungal treatment within the last month.

The yeast carriage rate was 83%, whereas 48% of the patients had clinical signs of OPC. Microscopy had low positive and negative predictive value (∼50%). Candida albicans accounted for half of the isolates cultured. No C. albicans isolate displayed acquired fluconazole resistance; however, 3 out of 12 isolates of normally fluconazole-susceptible species were fluconazole resistant. These were all from patients recently treated with azoles.

In total, 52% of culture-positive patients harbored at least one isolate with innately or acquired decreased fluconazole susceptibility. Therefore, susceptibility testing appears recommendable for patients with clinical signs of OPC.