Epidemiology, risk factors, treatment and outcome ofCandidabloodstream infections because ofCandida albicansandCandidanon-albicans in two district general hospitals in the United Kingdom

Introduction Bloodstream infections caused byCandidaspecies, known as candidemia are on the rise because of increasing complexity of surgical procedures, patient's underlying co-morbidities and shift in patient's demographics. This study was conducted to evaluate the epidemiology, risk factors, co-morbidities, antifungal treatment and outcomes of candidemia inCandida albicans (C. albicans) and Candida non-albicans(C. non-albicans) in East Sussex Healthcare Trust (ESHT), England. Material and Methods This retrospective and prospective study was performed during January 2006 to June 2017. Result A total of 102 episodes of candidemia on 100 patients (55 males) were identified.C. non-albicans were predominant (55%). All isolates were sensitive to amphotericin B, caspofungin and voriconazole while oneC. albicansand fiveC. non-albicans isolates were resistant to fluconazole. The risk factors inC. albicansandC. non-albicans groups were comparable which included intensive care unit (ICU) stay (15% vs 10%), the presence of intravascular line (35% vs 42%), previous antibiotic exposure (39% vs 49%), surgical intervention (19% vs 19%), mechanical ventilation (5% vs 8%), total parenteral nutrition (30% vs 27%) and urinary catheters (33 vs 38). The comorbidities in both groups (C. albicansandC. non-albicans) were solid organ cancer (15&14), haematology malignancy (1&3), steroid use (14&13), diabetes (9&7) and chemotherapy (2&4). Main sources of candidemia inC. albicanswere line (12), respiratory (10) and urinary tracts (6) while line (26) and urinary tract (9) were predominant inC. non-albicans group. Only a small number of patients underwent echocardiography (30%) and ophthalmology reviews (20%). A total of 45 fatal cases were recorded (C. albicans23). The highest mortality was seen in patients withC. albicansand among them the risk factors were elderly age group > 65 years (17/23), surgical intervention (9/23) and the history of ICU stay (7/23). Conclusion C. albicanscandidemia, >65 years of age and surgical procedure is associated with significant mortality, however, the use of fluconazole has shown the increased survival rate. This study suggests the surveillance of candidemia, and antifungal susceptibility pattern in current practice and the treatment.

Automated summary

This study investigated the epidemiology, risk factors, comorbidities, antifungal treatment, and outcomes of candidemia in East Sussex Healthcare Trust (ESHT), England. It found that non-albicans Candida species predominated (55%) and showed resistance to fluconazole. The main sources of candidemia were intravascular lines and urinary tracts for non-albicans Candida.