Epidemiological analysis of Nosocomial Candida infections: Experience of a university hospital

Abstract

Objective: A retrospective investigation was made in a university hospital setting of the distribution of Candida infections in terms of species, different clinical features of infections, risk factors for candidemia caused by these fungi and their antifungal susceptibilities. Method: This study was conducted between January 1st 2014 and December 31st 2017. Patients included in the study were those diagnosed with candida infection as a result of candida species, isolated from at least one clinical sample of those taken from hospitalized patients, including blood, urine and other clinical samples, and who were then administered antifungal therapy. The identification of candida species was performed using Matrix-Assisted Laser Desorption/Ionization Time-of-Mass Spectrometry (MALDI-TOF MS). Results: During the study period, the candida infection rate was found to be 5.86% in the 2760 episodes of infection and the incidence of candida infection was found to be 0.35 in 1000 bed days. The most common infection site for candida was the urinary tract (61.1%), followed by the blood-stream (31.5%). In 66% of all candida infections, Candida albicans was defined as the causative agent. The distribution of Candida glabrata , Candida tropicalis , Candida parapsilosis , Candida lusiteniae, Candida krusei and Candida kefyr were determined as 9.9%, 9.3%, 4.9%, 2.5%, 1.9% and 1.2%, respectively. The sensitivity to fluconazole and amphotericin B was determined as 97.2% and 99.1% in the C. albicans isolates, respectively. The sensitivity ratios for both fluconazole and amphotericin B were determined as 78.2% in the non-albicans strains. Multivariate logistic regression analysis showed that total parenteral nutrition (TPN) [Odds ratio (OR) 3.69, 95% Confidence interval, 1.595-8.570; p=0.002] was an independent risk factor for candidemia in patients with candida infection. Conclusions: C. albicans were the most encountered species in candida infections in our hospital. TPN was determined as an independent risk factor for the development of candidemia. Determinations of the species distribution of fungal infections and the antifungal sensitivity are important for the selection of effective treatment.