Dynamics and Predictors of Mortality Due to Candidemia Caused by Different Candida Species: Comparison of Intensive Care Unit-Associated Candidemia (ICUAC) and Non-ICUAC

Abstract

We investigated mortality and predictors of mortality due to intensive care unit-associated candidemia (ICUAC) versus non-ICUAC by Candida species. This study included all candidemia cases in 11 hospitals from 2017 to 2018 in South Korea. The all-cause mortality rates in all 370 patients with ICUAC were approximately twofold higher than those in all 437 patients with non-ICUAC at 7 days (2.3-fold, 31.1%/13.3%), 30 days (1.9-fold, 49.5%/25.4%), and 90 days (1.9-fold, 57.8%/30.9%). Significant species-specific associations with 7- and 30-day ICUAC-associated mortality were not observed. Multivariate analysis revealed that ICU admission was an independent predictor of Candida glabrata (OR, 2.07–2.48) and Candida parapsilosis-associated mortality (OR, 6.06–11.54). Fluconazole resistance was a predictor of C. glabrata-associated mortality (OR, 2.80–5.14). Lack (less than 3 days) of antifungal therapy was the strongest predictor of 7-day mortality due to ICUAC caused by Candida albicans (OR, 18.33), Candida tropicalis (OR, 10.52), and C. glabrata (OR, 21.30) compared with 30- and 90-day mortality (OR, 2.72–6.90). C. glabrata ICUAC had a stronger association with lack of antifungal therapy (55.2%) than ICUAC caused by other species (30.6–36.7%, all p < 0.05). Most predictors of mortality associated with ICUAC were distinct from those associated with non-ICUAC and were mediated by Candida species.

Nationwide Surveillance of Antifungal Resistance of Candida Bloodstream Isolates in South Korean Hospitals: Two Year Report from Kor-GLASS

“…In studies from the USA, northern Europe, and Australia, C. glabrata , which is less susceptible to antifungal drugs, was the second most common cause of candidemia [ 10 , 21 , 26 ], while in tropical and Asian countries, such as The Philippines and Thailand, C. tropicalis was the most prevalent NAC [ 22 , 27 ]. In the present study, most candidemia cases occurred in patients aged >60 years with C. glabrata BSIs being more frequent in the elderly (>70 years) and C. parapsilosis candidemia being more frequent in males, in line with our recent study [ 8 ]. The reasons for the changing epidemiology of NAC BSIs in South Korea are unclear, but the use of antifungal agents, infection control practices, and types of at-risk hospitalized patients enrolled may be factors [ 5 , 8 , 10 , 26 ].…”

“…In the present study, most candidemia cases occurred in patients aged >60 years with C. glabrata BSIs being more frequent in the elderly (>70 years) and C. parapsilosis candidemia being more frequent in males, in line with our recent study [ 8 ]. The reasons for the changing epidemiology of NAC BSIs in South Korea are unclear, but the use of antifungal agents, infection control practices, and types of at-risk hospitalized patients enrolled may be factors [ 5 , 8 , 10 , 26 ]. Given that each Candida species is unique in terms of virulence potential, antifungal susceptibility, and clinical characteristics, understanding the changing epidemiology is important for the proper management of candidemia [ 8 , 28 ].…”

“…In earlier multicenter studies conducted in South Korea, C. parapsilosis was the most common NAC isolated from patients with candidemia [ 16 , 23 , 24 ]. However, we found that, for the period from 2020–2021, C. glabrata and C. tropicalis were the most common NACs causing candidemia, consistent with recent reports on the changes in species distributions of candidemia in South Korea [ 8 , 25 ]. In studies from the USA, northern Europe, and Australia, C. glabrata , which is less susceptible to antifungal drugs, was the second most common cause of candidemia [ 10 , 21 , 26 ], while in tropical and Asian countries, such as The Philippines and Thailand, C. tropicalis was the most prevalent NAC [ 22 , 27 ].…”

“…Candida bloodstream infections (BSIs) are the most common nosocomial fungal infections and are associated with high rates of mortality [ 6 , 7 , 8 ]. Nationwide surveillance of the antifungal resistance of Candida BSI isolates is important because it provides an overview of the emerging resistance of Candida species [ 5 , 7 , 9 , 10 , 11 ].…”

Advances in prophylaxis and treatment of invasive fungal infections: perspectives on hematologic diseases

“…We compared the epidemiology of candidemia from previous studies ( Table 1 ). C. glabrata was the most common species among non-albicans species in Korea, similar in the United States [ 16 - 19 ]. C. tropicalis disputed this place in Asia-pacific region [ 20 ].…”