Abstract
Candida is an important cause of bloodstream infections (BSI), causing significant mortality and morbidity in health care settings. From January 2008 to December 2010 all consecutive patients who developed candidemia at San Martino University Hospital, Italy were enrolled in the study. A total of 348 episodes of candidaemia were identified during the study period (January 2008–December 2010), with an incidence of 1,73 episodes/1000 admissions. Globally, albicans and non-albicans species caused around 50% of the cases each. Non-albicans included Candida parapsilosis (28.4%), Candida glabrata (9.5%), Candida tropicalis (6.6%), and Candida krusei (2.6%). Out of 324 evaluable patients, 141 (43.5%) died within 30 days from the onset of candidemia. C. parapsilosis candidemia was associated with the lowest mortality rate (36.2%). In contrast, patients with C. krusei BSI had the highest mortality rate (55.5%) in this cohort. Regarding the crude mortality in the different units, patients in Internal Medicine wards had the highest mortality rate (54.1%), followed by patients in ICU and Hemato-Oncology wards (47.6%).This report shows that candidemia is a significant source of morbidity in Italy, with a substantial burden of disease, mortality, and likely high associated costs. Although our high rates of candidemia may be related to high rates of BSI in general in Italian public hospitals, reasons for these high rates are not clear and warrant further study. Determining factors associated with these high rates may lead to identifying measures that can help to prevent disease.
Highlights
Candida is an important cause of bloodstream infections (BSI), causing significant mortality and morbidity in health care settings
An increasing incidence of candidemia in Iceland was reported for the period between 1980 and 1999 [3], but the same was not observed in Switzerland, where a national surveillance study showed that the incidence of candidemia had remained unchanged during the period of 1991 to 2000 [2]
C. parapsilosis candidemia was associated with the lowest mortality rate (36.2%).In contrast, patients with C. krusei BSI had the highest mortality rate (55.5%) in this cohort
Summary
Candida is an important cause of bloodstream infections (BSI), causing significant mortality and morbidity in health care settings. The incidence of candidemia is growing with the increasing complexity of surgical procedures, the existence of patient populations at higher risk of infection, and the changes in patient demographic characteristics. Its overall incidence raised fivefold in the past ten years and Candida spp. is currently between the fourth and the sixth most common nosocomial bloodstream isolate in American and European studies [1,2]. It seems that differences do exist in the epidemiology of candidemia between different countries, underscoring the need for continuous surveillance to monitor trends in incidence, species distribution, and antifungal drug susceptibility profiles. The epidemiology of candidemia has been studied extensively in the United States, Europe, and some countries in South America
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