Epidemiology of Candidemia, Antifungal Susceptibilities of Candida Species and Their Impact on Mortality in Adult Patients Admitted to Akdeniz University Hospital

Objective: In this study, we aimed to determine the epidemiology of hospital-acquired candidemia, its incidence, prevalence of known risk factors, species distribution, their antifungal susceptibilities, and impact on mortality in adult patients. Methods: Between August 1, 2014 and May 31, 2016, 102 patients over the age of 18 who were hospitalized in the intensive care unit and other inpatient clinics of Akdeniz University Hospital with Candida spp. growing in at least one blood culture after 48 hours of hospitalization were prospectively evaluated. All isolates were identified to the species level. The Sensititre (TM) YeastOne (TM) (TREK Diagnostics, Thermo Fisher Scientific, East Grinstead, UK) panel was used for antifungal susceptibility testing. The results were evaluated according to Clinical and Laboratory Standards Institute (CLSI) M27-S4 and M60 documents. Results: The incidence of candidemia was 1.22 cases per 1.000 cases. Of the 102 patients, 37 (36.3%) had Candida albicans, 65 (63.7%) had non-albicans Candida species infection. C. albicans was identified as the most common species followed by 23 (22.5%) C. parapsilosis, 17 (16.7%) C. tropicalis and 13 (12.7%) C. glabrata. Use of broad spectrum antibiotics (98%) and presence of urinary catheter (96.1%) were the most common risk factors. Echinocandins showed good activity against Candida species. C. parapsilosis had 8.7% fluconazole and 4.4% voriconazole resistance, and C. tropicalis had 5.9% fluconazole and 5.9% voriconazole resistance. Two C. parapsilosis and one C. tropicalis with fluconazole resistance had also cross resistance to voriconazole. All strains were evaluated as wild strains according to the epidemiological thresholds of posaconazole and amphotericin B. Crude mortality rate associated with candidemia was 79.3%. Mechanical ventilation, central venous catheter use and total parenteral nutrition support increased mortality. Conclusions: Although Candida species with reduced sensitivity or intrinsic resistance are not a problem in our centre yet, identification at species level and antifungal susceptibility tests should be performed for isolates which cause candidemia.