Epidemiology of Candidemia: Three-Year Results from a Croatian Tertiary Care Hospital

Ivana Mareković,Tomislav Kuliš,Sanja Pleško,Marija Jandrlić,Violeta Rezo Vranješ,Zoran Herljević

doi:10.3390/jof7040267

Abstract

Invasive candidosis is the most common invasive fungal infection in hospitalized patients and is associated with a high mortality rate. This is the first study from a Croatian tertiary care hospital describing epidemiology, risk factors and species distribution in patients with candidemia. A three-year retrospective observational study, from 2018 to 2020, was performed at the University Hospital Centre Zagreb, Zagreb, Croatia. A total of 160 patients with candidemia (n = 170 isolates) were enrolled. Candidemia incidence increased from 0.47 to 0.69 per 1000 admissions in 2018 and 2020, respectively. Ninety-five patients (58.38%) were in the intensive care unit. The main risk factors for candidemia were central venous catheter (CVC) (84.38%), previous surgical procedure (56.88%) and invasive mechanical ventilation (42.50%). Candida albicans was identified in 43.53% of isolates, followed by C. parapsilosis (31.76%) and C. glabrata (12.36%), C. krusei (5.29%), C. tropicalis (2.35%) and C. lusitaniae (2.35%). The study discovered a shift to non-albicans Candida species, particularly C. parapsilosis, and made it possible to determine the main tasks we should focus on to prevent candidemia in the hospital, these being mainly infection control measures directed towards prevention of catheter-related bloodstream infections, specifically comprising hand hygiene and CVC bundles of care. The potential benefit of fluconazole prophylaxis in certain populations of surgical patients could also be considered.

Highlights

Invasive candidosis (IC) is the most common invasive fungal infection in hospitalized patients, especially in tertiary care hospitals
In a recent study analyzing the epidemiology of candidemia in Europe, the incidence rate for the total hospital-based setting was 0.83 per 1000 admissions per year, varying from
The functioning of healthcare systems, including hospitals, in 2020 was largely determined by the COVID-19 pandemic. It is still not clear whether COVID-19 patients show a higher incidence of candidemia

Summary

Introduction

Invasive candidosis (IC) is the most common invasive fungal infection in hospitalized patients, especially in tertiary care hospitals. Despite advances in the medical care of critically ill patients, IC is still considered difficult to diagnose, causes prolonged hospitalization and a mortality rate ranging from 20% to 40% and poses a significant financial burden for hospital healthcare systems. IC refers to bloodstream infections and deep-seated infections, including intra-abdominal abscess, peritonitis or osteomyelitis, the majority of epidemiological surveys on IC are still based solely on documented bloodstream infections—candidemia. This may be because this is the most common form of IC and due to the difficulties in diagnosing deep-seated infections without candidemia [1]. C. albicans continues to be the most prevalent Candida spp. in both adult and pediatric populations

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