Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

Abstract

The Candida species cause a majority of invasive fungal infections. In this article, we describe the nationwide epidemiology of candidemia in Kuwait in 2018. Yeast bloodstream isolates submitted from all major hospitals and identified by phenotypic MALDI-TOF MS and/or by molecular methods were studied. Susceptibility testing was performed by Etest. Out of 313 bloodstream yeasts, 239 Candida spp. isolates (excluding duplicate isolates) were obtained during 234 candidemic episodes among 223 patients. Mixed-species candidemia and re-infection occurred in 5 and 11 patients, respectively. C. albicans (n = 74), C. parapsilosis (n = 54), C. tropicalis (n = 35), C. auris (n = 33), C. glabrata (n = 32), other Candida spp. (n = 11), and other yeasts (n = 9) caused fungemia. Nearly 50% of patients were in intensive care units. Candida spp. isolates (except C. glabrata) were susceptible to caspofungin and 27% of C. auris were amphotericin B-resistant. Resistance to fluconazole was 100% in C. auris, 17% in C. parapsilosis, 12% in C. glabrata, and 1% in C. albicans. Mortality was 47% for other Candida/yeast infections. Nationwide candidemia incidence in 2018 was 5.29 cases/100,000 inhabitants. Changes in species spectrum, increasing fluconazole resistance in C. parapsilosis, and the emergence of C. auris as a major pathogen in Kuwait are noteworthy findings. The data could be of help in informing decisions regarding planning, in the allocation of resources, and in antimicrobial stewardship.

Increasing Incidence and Shifting Epidemiology of Candidemia in Greece: Results from the First Nationwide 10-Year Survey

“…The present epidemiological survey of the Greek all cause patient population (all hospital units) is representative of the entire country over a 10-year period providing a more complete picture. The survey has revealed an average annual incidence of 5.56/100,000 inhabitants (639 cases/year; 284, 209, and 146 in IMWs, ICU, and SWs patients, respectively), which is in line with reports from Ireland (6.3) [31], Kuwait (5.29) [32], Mexico (5.0) [33], and Sweden (4.7) [34]. The incidence is lower than that reported in Thailand (13.3) [35], Hungary (11.0) [36], Denmark (8.13) [37], and Spain (8.1) [38], and higher than in Canada (2.91) [39], Australia (2.41) [40], Portugal (2.19) [41], and the Philippines (2.0) [42].…”

“…The incidence of MC may vary from 1.5% to 18.5% [9,32,71,73,74]. In this study, MC occurred in 3% of episodes, with C. albicans being the most frequently isolated in combination with other Candida spp., consistent with the rates and distribution reported in previous multicentre studies conducted worldwide [32,[75][76][77][78]. Nevertheless, only 4/28 (14%) of the participating hospitals used chromogenic media, thus the incidence of MC might have been underestimated.…”

“…have undistinguishable colony morphologies on standard media that may not allow reliable differentiation, the routine use of chromogenic agars can increase significantly the detection rates of mixed species [71,72]. The incidence of MC may vary from 1.5% to 18.5% [9,32,71,73,74]. In this study, MC occurred in 3% of episodes, with C. albicans being the most frequently isolated in combination with other Candida spp., consistent with the rates and distribution reported in previous multicentre studies conducted worldwide [32,[75][76][77][78].…”

“…A short time ago, FLC resistance was considered to be uncommon among C. parapsilosis SC strains. While the phenomenon had appeared to be restricted to certain geographic regions, an ever-growing number of FLC-resistant clinical isolates have been reported worldwide from Brazil [57,83,84], France [85], India [86], Korea [87,88], Kuwait [32], North America [82], and South Africa [56,89], whilst the problem is already broadly disseminated in Italy [48,82,90] and Turkey [91][92][93]. FLC resistance C. parapsilosis SC has been well associated with selective drug pressure attributable to the extensive use of FLC as prophylaxis and treatment or even to exposure to systemic antimicrobials [94,95] with subsequent patient-to-patient spread in an epidemic way with clonal transmission and establishment of persistent resistant isolates within the hospital environment [83][84][85]92].…”

Strategies to Prevent Transmission of Candida auris in Healthcare Settings

“…In recent years, C. auris has caused invasive infections/outbreaks with increasing frequency which have been associated with high mortality rates among hospitalized patients [ 19 ••, 20 •, 21 , 40 – 43 ]. The increasing incidence of C. auris infections has also caused major shift in the epidemiology of invasive Candida infections at many geographical locations with C. auris becoming a major bloodstream pathogen, even surpassing C. glabrata or C. tropicalis in some settings [ 19 ••, 44 – 47 ].…”