Evaluation of epidemiological features, risk factors and clinical course in candidemia

Abstract

Objective: Candida species are among the most common causes of bloodstream infections and are associated with serious morbidity and mortality. Especially with the increasing number of patients receiving chemotherapy and other immunosuppressive treatment, developments in transplantation surgery, widespread use of broad spectrum antibiotics, the incidence of bloodstream infections caused by Candida species has increased in the last two decades. With the increase in the incidence of candidiasis, other Candida species are also increasing. With this change, increasing resistance to conventional treatments is also reported. In this study, it was aimed to evaluate the species distribution, resistance pattern, risk factors and clinical course in candidemia cases in the intensive care unit with a 3-year retrospective analysis. Methods: Hospital infection surveillance forms and medical records of patients who were followed up in Neurology Intensive Care Unit of our hospital’s and diagnosed with candidemia between January 2017-December 2019 were retrospectively evaluated. Results: In our study, Candida species were isolated in at least one blood culture from a total of 25 patients. The average age of the patients is 75.7 ± 11.8 (min 49-max 91). The average hospitalization day of the patients in the intensive care unit was 94.6 ± 63.7 (min 14-max 270) days. Non albicans Candida was isolated in twentythree (92%) of the patients. The most common species (92%) among non albicans candida is C. parapsilosis. Fluconazole resistance was 76% (n = 19) in patients with candidemia, and no resistance was found against anidulafungin and caspofungin. The mean period from admission to the detection of reproduction was 47.9 ± 26.9 days, six patients (24%) received fluconazole and nineteen (76%) received anidulafungin therapy. All patients had a history of antibiotherapy before kandidemia was detected, and the average duration of antibiotherapy before candidemia was 49.8 ± 28.3 (min 9-max 120) days. Mortality developed in 76% (n = 19) of the patients. Conclusion: We believe that the most common cause of candidemia is C. parapsilosis and high fluconazole resistance are important factors that should be considered in the treatment of these life-threatening infections in the neurology intensive care unit of our hospital