Epidemiology, Species Distribution, Antifungal Susceptibility, and Outcome of Candidemia across Five Sites in Italy and Spain

Abstract

Candidemia has become an important bloodstream infection that is frequently associated with high rates of mortality and morbidity, and its growing incidence is related to complex medical and surgical procedures. We conducted a multicenter study in five tertiary care teaching hospitals in Italy and Spain and evaluated the epidemiology, species distribution, antifungal susceptibilities, and outcomes of candidemia episodes. In the period of 2008 to 2010, 995 episodes of candidemia were identified in these hospitals. The overall incidence of candidemia was 1.55 cases per 1,000 admissions and remained stable during the 3-year analysis. Candida albicans was the leading agent of infection (58.4%), followed by Candida parapsilosis complex (19.5%), Candida tropicalis (9.3%), and Candida glabrata (8.3%). The majority of the candidemia episodes were found in the internal medicine department (49.6%), followed by the surgical ward, the intensive care unit (ICU), and the hemato-oncology ward. Out of 955 patients who were eligible for evaluation, 381 (39.9%) died within 30 days from the onset of candidemia. Important differences in the 30-day mortality rates were noted between institutions: the lowest mortality rate was in the Barcelona hospital, and the highest rate was in the Udine hospital (33.6% versus 51%, respectively; P ‫؍‬ 0.0005). Overall, 5.1% of the 955 isolates tested were resistant or susceptible dose dependent (SDD) to fluconazole, with minor differences between the hospitals in Italy and Spain (5.7% versus 3.5%, respectively; P ‫؍‬ 0.2). Higher MICs for caspofungin were found, especially with C. parapsilosis complex (MIC 90 , 1 g/ml). Amphotericin B had the lowest MICs. This report shows that candidemia is a significant source of morbidity in Europe, causing a substantial burden of disease and mortality.

Candidaemia in a tertiary care academic hospital in Italy. The impact of C. parapsilosis complex on the species distribution and antifungal susceptibility

“…In our study we found that the most frequently isolated species were C. albicans and C. parapsilosis complex (45.35 vs 35.27 %), with a significantly enhanced trend of isolation for the latter species. These data partly agree with those of other studies, in which C. albicans was the species most frequently isolated in the bloodstream in Europe and more specifically Italy (50 %) [5]. On the other hand, the incidence of C. parapsilosis complex was reported to range between 14 and 23 % [18,19].…”

“…from IVDs was found in the ICU, with a steady-state increased trend during the study period. Other studies reported similar results [5,19], even though they were not fully comparable to ours, since the data were reported as a percentage and not expressed as episodes/admission in the different wards. Furthermore, we observed a striking increase in candidaemia among medical patients.…”

“…Therefore, candidaemia trends might vary depending on the geographical setting of the hospital. To stress this observation, our data were found to be comparable to those recorded in another 1500-bed hospital in Rome in the period 2008-2010 (2.53 episodes/1000 admissions) [5], even though we did not consider onco-haematologically derived episodes. Accordingly to the literature, candidaemia episodes were mainly recorded in males aged 61-80 years (51.54 %) [5,18,19].…”

“…have been reported to be between the fourth and the sixth most common nosocomial bloodstream isolates in American and European studies [3,4]. However, the species distribution and the susceptibility profiles detected in the various hospitals evidenced discrepancies at the local level, with peculiarities among the hospitalization wards [5]. Indeed, patients hospitalized in intensive care units (ICUs) are generally considered to be at high risk of developing candidaemia, even though a generally increased incidence has been observed in other hospital wards [6,7].…”

Characteristics and clinical outcomes of patients with Candida bloodstream infections in a tertiary care hospital in Jordan

“…They are associated with prolonged hospitalization time and increased mortality [1][2][3][4]. Candida species are estimated to be the fourth pathogen isolated in blood cultures in North America and the fifth to tenth in Europe [5,6].…”