Risk factors and outcomes of Candidemia caused by non-albicans Candidain a tertiary hospital in Thailand

Abstract

Background: Candidemia is an important cause of severe sepsis in critically ill patients. The incidence of candidemia increased dramatically worldwide and the etiologic Candidaspecieshas been shifted from Candida albicans to non- albicans Candida. Candida tropicalisis highly prevalent in Asia. The risk factors and clinical outcomes in patients who had blood stream infection from non-albicans Candida is still unclear. Methods and materials: This is a retrospective review of medical records of patients with candidemia hospitalized at Siriraj Hospital, Thailand, from January 2016 to December 2017. Clinical characteristics, risk factors, treatment outcomes and antifungal susceptibility were analyzed. Results: A total of 156 patients were enrolled, 54.6% were male and the median age was 68 years. The underlying conditions included diabetes mellitus (32.1%), chronic cardiac disease (28.2%), chronic kidney disease (26.9%) and hematologic malignancies (21.2%). Candidaspecies isolated from patients’ blood were C. tropicalis (49.4%), C. albicans (28.8%), C. glabrata (16.7%) and C. parapsilosis (5.1%). Fluconazole resistance was significantly increased in C. tropicalis (37.8%) and C. albicans (14.3%). When compared with C. albicanscandidemia, no independent factor was found to be associated with non-albicans Candida candidemia. There was no significant difference in mortality rate between non-albicans Candida and C. albicanscandidemia [OR=1.35 (0.64–2.85)]. From multivariate analysis, when compared with C. albicanscandidemia, the independent factors associated with C. tropicaliscandidemia were chronic liver disease [OR = 11.39 (1.38–94.02)], neutropenia [OR = 4.31 (1.34–13.87)] and male gender [OR = 2.34 (1.04–5.29)]. Conclusion: In candidemic patients,chronic liver disease, neutropenia and male gender were associated with C. tropicalisrather than C. albicansinfection. Considering a higher fluconazole resistance in C. tropicalis, fluconazole should not be used for empirical antifungal treatment in such patients.