Candidaemia in Central Slovenia: A 12‐year retrospective survey

Abstract

Background Candida bloodstream infections (BSI) became an important invasive disease in the late 20th century, in particular among immunocompromised patients. Although considerable progress has been made in the management of patients with invasive mycoses, Candida BSI are still widespread among hospitalised patients and are associated with relatively high mortality. Objectives We conducted a retrospective study to evaluate patient characteristics, incidence, species distribution and antifungal susceptibility of BSI isolates of Candida spp. as well as outcomes of Candida BSI from 2001 to 2012, before the widespread use of echinocandins. This is the first epidemiological study of Candida BSI in Slovenia so far. Methods All documented candidaemia cases from 2001 to 2012 in two major hospitals—University Medical Centre and Institute of Oncology in Ljubljana, Slovenia—were taken into consideration. Candida BSI were identified in 422 patients (250 male, 172 female). Laboratory and clinical data of these patients were retrospectively analysed. Mann‐Whitney U test was used to compare continuous variables and Fisher's exact test or chi‐squared test for categorical variables. Results and conclusions The average incidence of Candida BSI was 0.524/10.000 patient‐days (0,317/1000 admissions); 16/422 were younger than 1 year and 251/422 patients were over 60 years old. The most commonly isolated species were Candida albicans and Candida glabrata, followed by Candida parapsilosis. Majority of the patients had a single episode of Candida BSI, multiple episodes of Candida BSI occurred in 18/434 patients (4.1%); in 25/434 patients (5.8%) mixed Candida BSI were observed. Crude 30‐day case‐fatality rate was 55.4%.

Attributable mortality of candidemia at a German tertiary hospital from 1997 to 2001 before the introduction of echinocandins

“…Similar results have been published in French and Italian studies 18,19 . A Slovenian study including all candidemia cases between 2001 and 2012 in two hospitals described an incidence of 3.2 per 10 000 admissions 20 …”

“…18,19 A Slovenian study including all candidemia cases between 2001 and 2012 in two hospitals described an incidence of 3.2 per 10 000 admissions. 20 Comorbidity rates reported by Gudlaugsson et al were higher compared to our study (CCI median for cases and controls 3.3 and 3.4 vs 3.0 and 3.0) as was the incidence of candidemia (5.2/10 000 Our study is limited by several factors. These include the retrospective study design, selection bias and a small study population.…”

“…Overall median time until discharge was longer for cases) than for controls(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), P =.003). Median time until discharge of surviving case and control patients was 23.5 (IQR 10.5-48) and 6 days (IQR 1-19.5, P >.001) respectively.…”

Systematic Characterization of Epidemiology, Antifungal Susceptibility, Risk Factors and Outcomes of Candidaemia: A Six-Year Chinese Study

“…Resistance to antifungal agents varies among Candida species in different regions. 13 , 14 Reduced in vitro susceptibility to azoles has been observed among Candida non- albicans species. 15 More than 95% of Candida albicans and Candida parapsilosis complex isolates were susceptible to all antifungal agents and fluconazole resistance rate in Candida tropicalis tripled over three years among 4010 Candida species which were reported in the CHIF-NET study in China.…”

“…The attributable mortality caused by candidaemia is reported to be 5%~58%. 10 , 13 , 18 Therefore, investigating the local epidemiology, monitoring the antifungal drug susceptibility, and identifying the potential risk factors of morbidity and mortality are essential for selecting the first-line antifungal agents and treatment measures to improve patient’s clinical outcomes.…”