Incidence and species distribution of candidaemia in Asia: a laboratory-based surveillance study

Abstract

The epidemiology of candidaemia varies between hospitals and geographic regions. Although there are many studies from Asia, a large-scale cross-sectional study across Asia has not been performed. We conducted a 12-month, laboratory-based surveillance of candidaemia at 25 hospitals from China, Hong Kong, India, Singapore, Taiwan and Thailand. The incidence and species distribution of candidaemia were determined. There were 1601 episodes of candidaemia among 1.2 million discharges. The overall incidence was 1.22 episodes per 1000 discharges and varied among the hospitals (range 0.16-4.53 per 1000 discharges) and countries (range 0.25-2.93 per 1000 discharges). The number of Candida blood isolates and the total number of fungal isolates were highly correlated among the six countries (R² = 0.87) and 25 hospitals (R² = 0.77). There was a moderate correlation between incidence of candidaemia and the intensive care unit (ICU)/total bed ratio (R² = 0.47), although ICUs contributed to only 23% of candidaemia cases. Of 1910 blood isolates evaluated, Candida albicans was most frequently isolated (41.3%), followed by Candida tropicalis (25.4%), Candida glabrata (13.9%) and Candida parapsilosis (12.1%). The proportion of C. tropicalis among blood isolates was higher in haemato-oncology wards than others wards (33.7% versus 24.5%, p 0.0058) and was more likely to be isolated from tropical countries than other Asian countries (46.2% versus 18.9%, p 0.04). In conclusion, the ICU settings contribute, at least in part, to the incidence variation among hospitals. The species distribution is different from Western countries. Both geographic and healthcare factors contribute to the variation of species distribution.

Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes

“…It appears that the species distribution in our institution is changing. Previous local studies reported a predominance of C. tropicalis , a finding commonly observed in tropical regions [10, 20]. We observed an increasing proportion of C. glabrata from 11% in 2008 to 31% in 2015, overtaking C. tropicalis as the predominant species.…”

“…This concurs with the general trend of stability in incidence reported in other developed countries, such as the United States and Europe [2, 17]. A recent study comparing candidemias among sites in Asia indicated that rates in Singapore (0.15 episodes per 1000 patient-days) were comparable with most other Asian countries, with the exception of Taiwan (0.37 per 1000 patient-days) and India (1.24 per 1000 patient-days) [10]. On a more global scale, our rates were lower than those in Italy (0.33 per 1000 patient-days) [18], and Brazil (0.37 per 1000 patient-days) [19].…”

“…The variable epidemiology of candidemia, contributed by the geographical and temporal variations in incidence and species distribution [4, 8–10], underscores the continuing need for local surveillance of Candida species distribution and susceptibility patterns.…”

The Global Burden of Fungal Diseases

“…3 Representative studies are listed in Table 1. [4][5][6][7][8][9][10][11][12][13][14] The reasons for these differences in candidemia incidence are likely multifactorial, including underlying ecology of Candida spp, differences in underlying patient populations, resources available for medical care and training programs, difficulties in implementing hospital infection control programs, and differences in surveillance methodologies. 3 Although a plethora of single-institution studies have been reported, only a few countries have conducted geographically widespread surveillance, and in still fewer countries has this been sustained over time to describe trends in candidemia.…”

Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia

“…The incidence of candidemia varies from 24 to 32.3 episodes/per 10,000 admissions 1, 3, 4 , and the mortality rate was 22–60% 2–6 . Recent strategies of antifungal prophylaxis or preemptive therapy for selected high-risk patients account for emergence of fluconazole resistant strains and an increased prevalence of non- albicans Candida species 7–9 .…”