Abstract
The Candida species cause a majority of invasive fungal infections. In this article, we describe the nationwide epidemiology of candidemia in Kuwait in 2018. Yeast bloodstream isolates submitted from all major hospitals and identified by phenotypic MALDI-TOF MS and/or by molecular methods were studied. Susceptibility testing was performed by Etest. Out of 313 bloodstream yeasts, 239 Candida spp. isolates (excluding duplicate isolates) were obtained during 234 candidemic episodes among 223 patients. Mixed-species candidemia and re-infection occurred in 5 and 11 patients, respectively. C. albicans (n = 74), C. parapsilosis (n = 54), C. tropicalis (n = 35), C. auris (n = 33), C. glabrata (n = 32), other Candida spp. (n = 11), and other yeasts (n = 9) caused fungemia. Nearly 50% of patients were in intensive care units. Candida spp. isolates (except C. glabrata) were susceptible to caspofungin and 27% of C. auris were amphotericin B-resistant. Resistance to fluconazole was 100% in C. auris, 17% in C. parapsilosis, 12% in C. glabrata, and 1% in C. albicans. Mortality was 47% for other Candida/yeast infections. Nationwide candidemia incidence in 2018 was 5.29 cases/100,000 inhabitants. Changes in species spectrum, increasing fluconazole resistance in C. parapsilosis, and the emergence of C. auris as a major pathogen in Kuwait are noteworthy findings. The data could be of help in informing decisions regarding planning, in the allocation of resources, and in antimicrobial stewardship.
Highlights
The past two decades have seen a gradual change in the spectrum of species causing candidemia, so much so that >50% of candidemia cases are caused by non-albicans Candida species, which mainly include C. glabrata complex members, C. parapsilosis complex members, and C. tropicalis as well as many emerging pathogens, likely as a result of the increasing use of fluconazole or other antifungal drugs for prophylaxis or therapy [6,14,17,18]
Excluding the Adan, Jahra, and Farwaniya hospitals, which have maternity wards and neonatal intensive care units (ICUs), the number of patients located in the ICU was lower in Amiri Hospital or significantly lower (p < 0.05) in Mubarak Al-Kabeer Hospital compared to the number of candidemia patients in Al-Sabah Hospital or Ibn-Sina Hospital (Table 3)
We determined the nationwide incidence of candidemia, the spectrum of Candida species, and their susceptibility to antifungal drugs in Kuwait in 2018
Summary
Previous epidemiological studies have shown that nearly 90% of all Candida infections are caused by only four species/species complexes, which include Candida albicans, Candida tropicalis, Candida parapsilosis, and Candida glabrata [8,12,13,14]. The past two decades have seen a gradual change in the spectrum of species causing candidemia, so much so that >50% of candidemia cases are caused by non-albicans Candida species, which mainly include C. glabrata complex members, C. parapsilosis complex members, and C. tropicalis as well as many emerging pathogens, likely as a result of the increasing use of fluconazole or other antifungal drugs for prophylaxis or therapy [6,14,17,18]. The emergence and rapid spreading of the often multidrug-resistant Candida auris has dramatically changed the epidemiology of candidemia at many geographical locations/health care facilities as it has become the most common or one of the more common causes of invasive Candida infections [22]
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