Candidemia among adults in Soweto, South Africa, 1990-2007

Background: Studies on candidemia occurring among adults in Southern African are limited. We aimed to document the epidemiology of candidemia among adults in Soweto. Methods: This was a retrospective hospital-based study in three discrete periods, involving 9 years, from 1990 to 2007. Results: Two hundred and sixty-six patients were identified. Case rates were 2.8 cases/10 000 admissions in 1998-2002 and 3.6 episodes/10 000 hospitalizations in 2005-2007. In 1990, Candida albicans caused 62% and Candida tropicalis caused 23% of episodes. In 2005-2007, major species were C. albicans (46%), Candida parapsilosis (25%), and Candida glabrata (23%), with little change compared to 1998-2002. Major predisposing conditions were abdominal surgery (43%), HIV infection (19% in 2005-2007), trauma (16%), diabetes mellitus (12%), and cancer (8%). General wards superseded intensive care as the major diagnostic setting in 2005-2007. The crude mortality was 60%. Among 22 HIV-infected patients with a median CD4 cell count of 68/mu l, three were of community-onset. C. albicans caused 73% of cases. Five patients had another predisposing condition and five had central venous catheters. The mortality was 73%. Conclusions: Soweto has a pattern of Candida species different from other continents. HIV infection and trauma were important predisposing conditions. (C) 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.