Importance of Candida species isolated from blood culture: Distribution, antifungal susceptibility, mortality: Candida infections

Rabiye Altınbaş

doi:10.5281/zenodo.8329993

Authors

Rabiye Altınbaş Dr. Ersin Arslan Training and Research Hospital, Department of Mycology, Gaziantep, Turkey https://orcid.org/0000-0003-2535-0480

DOI:

https://doi.org/10.5281/zenodo.8329993

Keywords:

Antifungal resistance, candidemia, invasive candidiasis, non albicans Candida

Abstract

Objective: Candidemia is a bloodstream infection arising from Candida species that is difficult to diagnose and treatment. Despite advancements in antifungal therapy, candidemia still causes high-mortality rates, prolonged hospital stays and increased healthcare costs. The purpose of this study was to analyze the Candida species distribution, antifungal susceptibility, and mortality rate of isolates from candidemia patients in a tertiary city hospital.

Methods: We designed a retrospective observational study of hospitalized patients with candidemia. Data were collected from the medical records of 39 patients with positive blood culture candidemia cases between November 2018 and February 2020 at a city hospital.

Results: Candida albicans was the predominant species (n=17; 43.6%) followed by the Candida glabrata complex (n=13; 33.3%), Candida parapsilosis complex (n=8; 20.5%), and Candida kefyr (n=1; 2.6%). The C. glabrata complex was the predominant species among the NAC. All Candida isolates were susceptible to fluconazole, voriconazole and amphotericin B. Overall, the level of antifungal resistance was low. C. albicans, C. parapsilosis complex and C. kefyr isolates did not show resistance. The mortality rate attributed to all cases within 30 days after candidemia was found to be higher in NAC: C. glabrata complex (84.6%), C. parapsilosis complex (75.0%). and C. kefyr (100.0%). The mortality rate of the 39 patients was 69.2%.

Conclusion: Candidemia is an emerging problem in developing countries and is a significant source of mortality, morbidity, and likely high costs associated with care in hospitalized patients in Turkey.

References

Sardi JCO, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJS. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol. 2013;62:10–24.

Bal AM, Palchaudhuri M. Candidaemia in the elderly: Epidemiology, management and adherence to the European Confederation of Medical Mycology quality indicators. Mycoses. 2020;63:892–9.

Pfaller MA, Diekema DJ, Turnidge JD, Castanheira M, Jones RN. Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997–2016. Open Forum Infect Dis. 2019;6:S79–94.

Alp S, Arikan-Akdagli S, Gulmez D, Ascioglu S, Uzun O, Akova M. Epidemiology of candidaemia in a tertiary care university hospital: 10-year experience with 381 candidaemia episodes between 2001 and 2010. Mycoses. 2015;58:498–505.

Wan Ismail WNA, Jasmi N, Khan TM, Hong YH, Neoh CF. The Economic Burden of Candidemia and Invasive Candidiasis: A Systematic Review. Value Heal Reg Issues. 2020;21:53–8.

Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:409–17.

De Francesco MA, Piccinelli G, Gelmi M, Gargiulo F, Ravizzola G, Pinsi G, et al. Invasive Candidiasis in Brescia, Italy: Analysis of Species Distribution and Antifungal Susceptibilities During Seven Years. Mycopathologia. 2017;182:897–905.

Mohr A, Simon M, Joha T, Hanses F, Salzberger B, Hitzenbichler F. Epidemiology of candidemia and impact of infectious disease consultation on survival and care. Infection. 2020;48:275–84.

Rajendran R, Sherry L, Deshpande A, Johnson EM, Hanson MF, Williams C, et al. A Prospective Surveillance Study of Candidaemia: Epidemiology, Risk Factors, Antifungal Treatment and Outcome in Hospitalized Patients. Front Microbiol. 2016;7:1–8.

Klingspor L, Ullberg M, Rydberg J, Kondori N, Serrander L, Swanberg J, et al. Epidemiology of fungaemia in Sweden: A nationwide retrospective observational survey. Mycoses. 2018;61:777–85.

Lortholary O, Renaudat C, Sitbon K, Desnos-Ollivier M, Bretagne S, Dromer F. The risk and clinical outcome of candidemia depending on underlying malignancy. Intensive Care Med. 2017;43:652–62.

Pinto-Magalhães S, Martins A, Lacerda S, Filipe R, Prista-Leão B, Pinheiro D, et al. Candidemia in a Portuguese tertiary care hospital: Analysis of a 2-year period. J Mycol Med. 2019;29:320–4.

Yardimci AC, Arman D. Changing Trends of Candida Species and Antifungal Susceptibility Profile of Candida Bloodstream Isolates: A 5-Year Retrospective Survey. Jundishapur J Microbiol. 2021;14:e120801.

Pfaller MA, Castanheira M, Messer SA, Moet GJ, Jones RN. Variation in Candida spp. distribution and antifungal resistance rates among bloodstream infection isolates by patient age: report from the SENTRY Antimicrobial Surveillance Program (2008–2009). Diagn Microbiol Infect Dis. 2010;68:278–83.

Chapman B, Slavin M, Marriott D, Halliday C, Kidd S, Arthur I, et al. Changing epidemiology of candidaemia in Australia. J Antimicrob Chemother. 2017;72(4):1103-8.

Arastehfar A, Yazdanpanah S, Bakhtiari M, Fang W, Pan W, Mahmoudi S, et al. Epidemiology of candidemia in Shiraz, southern Iran: A prospective multicenter study (2016–2018). Med Mycol. 2021;59:422–30.

Yeşilkaya A, Azap Ö, Aydın M, Akçil OM. Epidemiology, species distribution, clinical characteristics and mortality of candidaemia in a tertiary care university hospital in Turkey, 2007-2014. Mycoses. 2017;60:433–9.

Mete B, Zerdali EY, Aygun G, Saltoglu N, Balkan II, Karaali R, et al. Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience). Eur J Clin Microbiol Infect Dis. 2021;40:325–33.

Ergon MC, Doluca DM, Ener B, Atalay MA, Koç AN, Çerikçioğlu N, et al. Türkiye’de Altı Yıllık Zaman Dilimi İçerisinde Kan Kültürlerinden Soyutlanan Maya Mantarlarının Tür Dağılımı: Çok Merkezli Bir Çalışma. Mikrobiyol Bul. 2020;54:638–46.

Muderris T, Kaya S, Ormen B, Aksoy Gokmen A, Varer Akpinar C, Yurtsever Gul S. Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study. J Mycol Med. 2020;30:101008.

Pfaller MA, Diekema DJ, Gibbs DL, Newell VA, Ellis D, Tullio V, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10.5-Year Analysis of Susceptibilities of Candida Species to Fluconazole and Voriconazole as Determined by CLSI Standardized Disk Diffusion. J Clin Microbiol. 2010;48:1366–77.

Tortorano A, Kibbler C, Peman J, Bernhardt H, Klingspor L, Grillot R. Candidaemia in Europe: epidemiology and resistance. Int J Antimicrob Agents. 2006;27:359–66.

Posteraro B, De Carolis E, Criscuolo M, Ballanti S, De Angelis G, Del Principe MI, et al. Candidaemia in haematological malignancy patients from a SEIFEM study: Epidemiological patterns according to antifungal prophylaxis. Mycoses. 2020;63:900–10.

Astvad KM, Perlin DS, Johansen HK, Jensen RH, Arendrup MC. Evaluation of caspofungin susceptibility testing by the new Vitek 2 AST-YS06 yeast card using a unique collection of FKS wild-type and hot spot mutant isolates, including the five most common Candida species. Antimicrob Agents Chemother. 2013;57:177–82.

Boan P, Gardam D. Epidemiology and antifungal susceptibility patterns of candidemia from a tertiary centre in Western Australia. J Chemother. 2019;31:137–40.

Dizbay M, Kalkanci A, Sezer BE, Aktas F, Aydogan S, Fidan I, et al. Molecular investigation of a fungemia outbreak due to Candida parapsilosis in an intensive care unit. Brazilian J Infect Dis. 2008;12:395–9.

Dalyan Cilo B, Agca H, Ener B. Identification of Candida parapsilosis Complex Strains Isolated from Blood Samples at Species Level and Determination of Their Antifungal Susceptibilities. Türk Mikrobiyoloji Cemiy Derg. 2019;49:61–6.

Ulu KA, Alp E, Cevahir F, Ture Z, Yozgat N. Epidemiology and cost implications of candidemia, a 6-year analysis from a developing country. Mycoses. 2017;60:198–203.

Arikan-Akdagli S, Gülmez D, Doğan Ö, Çerikçioğlu N, Doluca Dereli M, Birinci A, et al. First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey. J Glob Antimicrob Resist. 2019;18:230–4.

Dizbay M, Fidan I, Kalkanci A, Sari N, Yalcin B, Kustimur S, et al. High incidence of Candida parapsilosis candidaemia in non-neutropenic critically ill patients: Epidemiology and antifungal susceptibility. Scand J Infect Dis. 2010;42:114–20.

Bae GY, Lee HW, Chang SE, Moon KC, Lee MW, Choi JH, et al. Clinicopathologic review of 19 patients with systemic candidiasis with skin lesions. Int J Dermatol. 2005;44:550–5.

Jia X, Li C, Cao J, Wu X, Zhang L. Clinical characteristics and predictors of mortality in patients with candidemia: a six-year retrospective study. Eur J Clin Microbiol Infect Dis. 2018;37:1717–24.

Sbrana F, Sozio E, Bassetti M, Ripoli A, Pieralli F, Azzini AM, et al. Independent risk factors for mortality in critically ill patients with candidemia on Italian Internal Medicine Wards. Intern Emerg Med. 2018;13:199–204.

Ala-Houhala M, Valkonen M, Kolho E, Friberg N, Anttila V-J. Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007–2016. Infect Dis (Lond). 2019;51:824–30.

Koçak BY, Kuloğlu F, Doğan ÇA, Akata F. Evaluation of epidemiological characteristics and risk factors of candidemia in adult patients in a tertiary-care hospital. Mikrobiyol Bul. 2011;45:489–503.

Pfaller MA, Andes DR, Diekema DJ, Horn DL, Reboli AC, Rotstein C, et al. Epidemiology and Outcomes of Invasive Candidiasis Due to Non-albicans Species of Candida in 2,496 Patients: Data from the Prospective Antifungal Therapy (PATH) Registry 2004–2008. PLoS One. 2014;9:e101510.

Hii I-M, Chang H-L, Lin L-C, Lee Y-L, Liu Y-M, Liu C-E, et al. Changing epidemiology of candidemia in a medical center in middle Taiwan. J Microbiol Immunol Infect. 2015;48:306–15.

Cheng M-F, Yang Y-L, Yao T-J, Lin C-Y, Liu J-S, Tang R-B, et al. Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species. BMC Infect Dis. 2005;5:22.

Haghighatfard A, Abbasi S, Alijani P, Akbari FA, Rashidi H, Dehghan P. Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia in intensive care units in Isfahan, Iran. Curr Med Mycol. 2022;8:30–4.