Risk Factors of Candida parapsilosis Catheter-Related Bloodstream Infection

Abstract

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080–0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125–8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.

Antimicrobial Resistance and Biofilms Underlying Catheter-Related Bloodstream Coinfection by Enterobacter cloacae Complex and Candida parapsilosis

“…The presence of rod-shaped bacilli and yeast was consistent with the identified etiological agents: the E. cloacae complex ( E. bugandensis ) and C. parapsilosis, but the observed microbial communities were not consistent with mature biofilms. Attached microorganisms were predominantly C. parapsilosis , which is consistent with published reports on the enhanced ability of this microorganism to form biofilms on medical devices [ 38 ]. The use of WGS confirmed the identity between the microorganisms isolated from the CVC and HC, confirming the CVCs mediated BSI.…”

“…CRBSIs are a serious healthcare concern, especially among intensive care unit patients and patients with comorbidities such as renal impairment, cancer and diabetes [ 38 , 39 ]. Polymicrobial infections should represent a major challenge compared to monomicrobial infections although there is no conclusive evidence for this [ 40 , 41 ].…”

Changing Trends of Candida Species and Antifungal Susceptibility Profile of Candida Bloodstream Isolates: A 5-Year Retrospective Survey

“…Candidaparapsilosis has emerged as an important nosocomial pathogen (41). In the current study, the sensitivity of fluconazole decreased by 55% in C. parapsilosis (which is the second most common yeast pathogen in BSI), suggesting that it may be associated with clonal outbreaks of fluconazole-resistant C. parapsilosis.…”

A Case Report on Recurrent Intestinal Obstruction with Relapsing Klebsiella and Candida Sepsis in a 6 Years Old Patient: A Rare Case Report from South India

“…Catheter-related bloodstream infections (CRBSI) increase mortality rates, duration of stay, and hospital expenditures, all of which have an effect on the patients' prognosis and quality of life. Removal of the catheter alone is not an adequate treatment for Candidemia; it has to be combined with an antifungal therapy [15,16].…”