Factors related to outcome of bloodstream infections due to Candida parapsilosis complex

Abstract

BackgroundAlthough Candida albicans is the most common cause of fungal blood stream infections (BSIs), infections due to Candida species other than C. albicans are rising. Candida parapsilosis complex has emerged as an important fungal pathogen and became one of the main causes of fungemia in specific geographical areas. We analyzed the factors related to outcome of candidemia due to C. parapsilosis in a single tertiary referral hospital over a five-year period.MethodsA retrospective observational study of all cases of candidemia was carried out at a 980-bedded University Hospital in Italy. Data regarding demographic characteristics and clinical risk factors were collected from the patient’s medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to CLSI species-specific clinical breakpoints.ResultsOf 270 patients diagnosed with Candida BSIs during the study period, 63 (23 %) were infected with isolates of C. parapsilosis complex which represented the second most frequently isolated yeast after C. albicans. The overall incidence rate was 0.4 episodes/1000 hospital admissions. All the strains were in vitro susceptible to all antifungal agents. The overall crude mortality at 30 days was 27 % (17/63), which was significantly lower than that reported for C. albicans BSIs (42 % [61/146], p = 0.042). Being hospitalized in ICU resulted independently associated with a significant higher risk of mortality (HR 4.625 [CI95% 1.015–21.080], p = 0.048). Conversely, early CVC removal was confirmed to be significantly associated with a lower risk of mortality (HR 0.299 [CI95% 0.102–0.874], p = 0.027). Finally, the type of primary antifungal therapy did not influence the outcome of infection.ConclusionsCandidemia due to C. parapsilosis complex, the second most commonly causative agent of yeast BSIs in our center, is characterized by a non-negligible mortality at 30 days. An early CVC removal is associated with a significant reduced mortality.

Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

“…Overall 30‐days mortality for C parapsilosis was found to be lower compared to C albicans and C glabrata and compared to rarer species, nevertheless it was greater than in other experiences (23%‐27%) …”

Candidaemia in a tertiary care academic hospital in Italy. The impact of C. parapsilosis complex on the species distribution and antifungal susceptibility

“…In recent years very few data have been available concerning the significantly enhanced trend for isolation of C. parapsilosis complex as a causative agent for candidaemia [24]. A recent observational study conducted in the centre of Italy showed that during the years 2010-2014, C. parapsilosis complex had a high incidence rate of isolation, and that the hospitalization in the ICU was independently associated with a significantly higher risk of mortality [7]. Unfortunately, no data are available concerning the relative risk of mortality associated with candidaemia.…”

“…However, the species distribution and the susceptibility profiles detected in the various hospitals evidenced discrepancies at the local level, with peculiarities among the hospitalization wards [5]. Indeed, patients hospitalized in intensive care units (ICUs) are generally considered to be at high risk of developing candidaemia, even though a generally increased incidence has been observed in other hospital wards [6,7]. Treatment of candidaemia mainly consists of the application of antifungal agents such as fluconazole, amphotericin B and, more recently, echinocandins.…”

Utility of two PCR‐RFLP‐based techniques for identification of Candida parapsilosis complex blood isolates

“…The incidence of nosocomial infections caused by Candida has risen significantly in recent decades. Among this genus, C. parapsilosis is the species that has most notably increased in incidence, causing 10%‐25% of candidaemias in neonates and patients in intensive care units 5,17,24 . Candida parapsilosis infections are associated with the use of medical devices, such as central venous catheters, parenteral nutrition administration and healthcare worker contact 5,25‐28 .…”

“…External acquisition by medical devices is considered an important route of C. parapsilosis infection, and prolonged catheterisation has been demonstrated to be the most important underlying condition, with this factor being of greater relevance to the C. parapsilosis species complex than to C. albicans 2,5,16,17 . In 2015, Barbedo et al observed that the species identified in the catheter was not always responsible for the bloodstream infection, and different cryptic species of the C. parapsilosis complex could be identified in the same patient from both samples 18 …”