Evaluation of epidemiology, risk factors, antifungal susceptibilities and mortality of candidaemia in adult patients admitted to Akdeniz University Medical School Hospital

Hospital-acquired invasive fungal infections are known as the cause of serious morbidity and mortality due to the fact that they are rapidly progressing with severe course, difficult to diagnose and treatment resistant infections. Studies have shown that agents of candidaemia change between countries, years in the same country, or between hospitals, both in terms of incidence and agent spectrum. Between August 1, 2014 and May 31, 2016, adult patients over the age of 18who were hospitalized in the intensive care and other inpatient services of Akdeniz University Hospital and who had Candida growth in routine blood cultures were evaluated prospectively terms of risk factors, Candida types, antifungal susceptibilities, duration of hospitalization, morbidity and mortality according to Candida spp. One hundred and two patients who had Candida spp. growth in at least one blood culture 48 hours after admission to the hospital and who were diagnosed with hospital-acquired candidaemia in accordance with the CDC criteria were included in the study. Demographic characteristics, underlying diseases, risk factors, clinical data, microbiological data, antifungal susceptibility, antifungal and antibacterial treatments and their results of the patients were recorded in a follow-up form. The incidence rate of candidaemia was 1.22 cases per 1,000 cases. Of the 102 candidaemia patients, 37 (36.3%) had C.albicans, while 65 (63.7%) had non-albicans Candida.C. albicans has been identified as the most common species followed by C. parapsilosis 23 (22.5%), C. tropicalis 17 (16.7%) and C. glabrata 13 (12.7%). The most frequent risk factors were the use of broad spectrum antibiotics (98%), presence of urinary catheter (96.1%), accompanying hospital acquired infection (92.2%) and central venous catheter (80.4%) . Gastrointestinal system bleeding increased the risk of C. Albicans. Antifungal susceptibility tests of all Candida species were studied (anidulofungin, caspofungin, micafungin, fluconazole, voriconazole, itraconazole, flucytosine and amphotericin B). The colorimetric microdilution method Sensititer Yeast One panel was used as antifungal susceptibility test (TREK diagnostics, Thermofisher, United Kingdom). The evaluation of the Sensititer Yeast One panel is based on CLSI M27-S4 data. According to this among all Candida strains, the highest resistance was found in voriconazole (2.9%) and fluconazole (2.9%). No antifungal resistance was detected in C. albicans strains. Among non-albicans Candida, C. parapsilosis had 8.7% fluconazole and 4.3% voriconazole, C. tropicalis 5.9% fluconazole and 5.9% voriconazole, C. tropicalis 5.9% fluconazole and 5.9% voriconazole resistance. Voriconazole resistance was detected in 12.5% of C. krusei. The crude mortality rate associated with candidaemia was 79.3%. Although mechanical ventilator and central venous catheter use and total parenteral nutritional support increased mortality, other risk factors did not have any effect on mortality. Diabetes mellitus was the most common underlying disease followed by oncologic malignancy. Candidaemia is most commonly caused by C. albicans, followed by C. parapsilosis and C. tropicalis. Candida species with reduced sensitivity or which are intrinsically resistant to antifungal agents are not yet a problem in our center. The risk factors determined in our study may be used for early recognition of patients at risk of developing candidaemia and may guide the initiation of preemptive and prophylactic antifungal therapy.