Abstract
BackgroundCandidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum antifungal agents worldwide. Our study aimed to identify the occurrence of antifungal-resistant candidaemia and the distribution of these species, determine the risk factors associated with antifungal resistance and evaluate the association of antifungal-resistant candidaemia with the length of intensive care unit (ICU) and hospital stay and with 30-day mortality.MethodsA retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia. Adult patients diagnosed with candidaemia from January 2006 to December 2017 were included.ResultsA total of 196 BSIs were identified in 94 males (49.74%) and 95 females (50.26%). C. glabrata was the most commonly isolated Candida species, with 59 (30%), followed by C. albicans with 46 (23%). Susceptibility data were available for 122/189 patients, of whom 26/122 (21%) were resistant to one or more antifungals. C. parapsilosis with available sensitivity data were found in 30/122 isolates, of which 10/30 (33%) were resistant to fluconazole. Risk factors significantly associated with antifungal-resistant candidaemia included previous echinocandin exposure (odds ratio (OR) =1.38; 95% confidence interval (CI) (1.02–1.85); P = 0.006) and invasive ventilation (OR = 1.3; 95% CI (1.08–1.57); P = 0.005). The median length of ICU stay was 29 days [range 12–49 days] in the antifungal-resistant group and 18 days [range 6.7–37.5 days] in the antifungal-sensitive group (P = 0.28). The median length of hospital stay was 51 days [range 21–138 days] in the antifungal-resistant group and 35 days [range 17–77 days] in the antifungal-sensitive group (P = 0.09). Thirty-day mortality was 15 (57.7%) and 54 (56.25%) among the antifungal-resistant and antifungal-sensitive groups, respectively (OR = 1.01; 95% CI (0.84–1.21); P = 0.89).ConclusionsOur results indicate a high frequancy of non- C. albicans candidaemia. The rise in C. parapsilosis resistance to fluconazole is alarming. Further studies are required to confirm this finding.
Highlights
Candidaemia is the most common form of invasive candidiasis
Demographic characteristics and risk factors associated with resistant Candida blood stream infection (BSI) are listed in (Table 1)
One hundred and twenty-two patients with antifungal susceptibility data were analysed in the candidaemia resistance risk factor analysis (Table 3); the percentage of antifungal resistance was 21% (26/122)
Summary
Candidaemia is the most common form of invasive candidiasis. Resistant Candida blood stream infection (BSI) is rising, with limitations on the development of broader-spectrum antifungal agents worldwide. Candidaemia is the most common form of invasive candidiasis (IC), which accounts for 9% of all nosocomial bloodstream infections (BSIs) [2, 3]. In a 2014 United States (US) surveillance study, Candida species ranked as the seventh causative organism of healthcare-associated. Recent reports indicated that candidaemia is the third or fourth most common hospital-acquired BSI in US hospitals [5]. Candida species are considered the leading pathogen in many fungal infections affecting humans. Among 15 distinct Candida species causing human disease, C. albicans, C. glabrata, C. tropicalis, C. parapsilosis and C. krusei are the most common pathogens leading to IC [5]
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