Epidemiology, species distribution, and predictive factors for mortality of candidemia in adult surgical patients

Abstract

Background: We evaluated the epidemiology, clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018. Methods: We designed a retrospective observational study of adult patients with candidemia in a teaching hospital including three hospital campuses. Data regarding clinical and demographic characteristics were collected from the patient's medical records. Results: Of the 236 cases of candidemia, 172 (72.9%) were identified in surgical patients, including 146 (84.9%) general surgeries, 11 (6.4%) urologic surgeries, 6 (3.5%) thoracic surgeries, and others. Higher proportions of solid tumors, total parenteral nutrition, the presence of a urinary catheter, and the presence of a gastric tube were observed in surgical patients with candidemia versus non-surgical ones, whereas the percentages of hematological malignancy, diabetes mellitus, and renal replacement therapy were relatively lower in surgical patients. Renal failure, leukopenia, and thrombocytopenia were less common laboratory findings in surgical patients with candidemia than compared to non-surgical ones. Among surgical patients with candidemia, Candida parapsilosis was the predominant species (43%), followed by C. albicans (33.7%), C. glabrata (11%), C. tropicalis (8.1%), and others (4.1%). Overall susceptibility, susceptible dose dependent or intermediate susceptibility, and resistance to fluconazole were detected in 73.3, 19.8, and 3.5% Candida isolates from surgical patients, respectively, but no resistance to amphotericin B was observed. Overall, the 30-day mortality in surgical patients was 19.2%. At multivariable analysis, independent risk factors for death in surgical patients with candidemia were ICU stay, thrombocytopenia, and C. albicans infection. Conclusions: Surgical patients account for the majority of candidemia cases. Among patients with recent surgery, risk factors for species distribution, antifungal sensitivity patterns of Candida isolates causing candidemia, and independent risk factors for mortality should be evaluated and considered for a better outcome in the antifungal treatment.

Changing Trends of Candida Species and Antifungal Susceptibility Profile of Candida Bloodstream Isolates: A 5-Year Retrospective Survey

“…According to the studies conducted in Turkey, the most frequent species were C. albicans, C. parapsilosis, C. tropicalis, and C. glabrata (7, 11, 27, 29, 30), which is in line with other studies in the literature (6, 16,17,21,22,24,26). Candidaparapsilosis was reportedly the most frequent species in some studies (27,31,32), whereas C. glabrata was the leading species in the studies of Israel et al (19) and Aldardeer et al (33). The prevalence of isolated Candida spp.…”

Single and Repeated Episodes of Candida Species Isolated From Cerebrospinal Fluid for Diagnosing Probable Candida meningitis

“…Previous studies indicated that non-C. albicans species accounted for over two-thirds of isolates from blood in China (Xiao et al, 2020;Zhang et al, 2020). In the present study, we found that the percentage of non-C. albicans exceeded 70%, and non-C. albicans species had higher trends of resistance to azoles than C. albicans.…”

Epidemiology of Candidemia: Three-Year Results from a Croatian Tertiary Care Hospital

“…The significance of previous surgical procedures as a risk factor for candidemia, especially abdominal surgery, has been demonstrated in many previous publications [ 21 , 22 , 23 , 24 ]. Among 160 patients with candidemia in our study, 91 (56.88%) had undergone a previous surgical procedure, predominantly an abdominal type of surgery.…”