Incidence of candidemia and prevalence of azole-resistant candidemia at a tertiary South African hospital – A retrospective laboratory analysis 2016–2020

Abstract

Coupled with the limited number of antifungal classes for management of fungal infections is the limited access to available antifungal agents in many countries worldwide. 2 This is becoming increasingly important with the changing epidemiology of candidemia, with species distribution Background: Candidemia is associated with high morbidity and mortality. The epidemiology of candidemia has changed globally over the past 20 years. South African surveillance demonstrated a shift in epidemiology from Candida albicans to non-albicans species including Candida parapsilosis and Candida auris. Hospital-level candidemia incidence from South Africa has not been reported previously. Methods:We performed a retrospective laboratory-based analysis of blood cultures with confirmed causative agents of candidemia. Ward type, department, gender and admission to critical care units were captured. Data were analysed in Microsoft Excel, Statistical Package for the Social Sciences (SPSS) and Epitools. Results:The incidence of candidemia during the study period was 2.87 per 1000 admissions. The total proportion of non-albicans species causing candidemia was 425/618 (69.7%). Overall, 65.4% of candidemia cases occurred in non-critical care units. There was a significant increase in the proportion of C. auris isolates between 2016 and 2020 (p < 0.001). Isolation of C. auris was associated with admission to critical care units (p < 0.001, odds ration [OR] 3.856, 95% confidence interval [CI]: 2.360-6.300). The proportion of azole-resistant candidemia cases increased from 21/53 (39.6%) in 2016 to 41/59 (69.5%) in 2020 (p = 0.002). Conclusion:The incidence of candidemia remained stable over the five-year study period. However, the proportion of C. auris isolates increased significantly during the study period as did the overall proportion of azole-resistant candidemia. Antifungal stewardship and continued hospital-level surveillance are imperative.

Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children

“…According to the 22 publications of C. auris infection, comprising 256 children [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], reviewed herein, the most common type of invasive infection was bloodstream infection (94%, 194/206 patients with available data on the infection site) ( Table 3 and Table S1 ). The duration of candidemia was not reported in most studies and was available for only seven patients; the duration ranged between 7 and 11 days [ 16 , 20 , 36 ].…”

“…Following exclusion of suspected repetitive studies, the search yielded 23 publications that reported C. auris incidents in children [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Twelve publications included both adult and pediatric patients [ 17 , 19 , 20 , 23 , 24 , 26 , 27 , 28 , 32 , 35 , 36 , 37 ]; of them, one did not provide specific details of the pediatric patients and was excluded [ 26 ]. Six provided limited specific details of the pediatric patients [ 17 , 19 , 24 , 27 , 37 ].…”

“…Six provided limited specific details of the pediatric patients [ 17 , 19 , 24 , 27 , 37 ]. Five publications included data of other Candida species with limited data specific to C. auris infections [ 18 , 26 , 29 , 30 , 35 ]. Overall, 22 studies were included, involving about 250 C. auris cases in children.…”

Modeling Candida auris skin colonization: Mice, swine, and humans

“…Since identification in 2009, C . auris has rapidly spread around the world, now accounting for 20% to 30% of Candida bloodstream infections in some healthcare settings [ 6 , 7 ]. Prior to development of invasive disease, C .…”

“…It is the first fungal pathogen to be labeled as an urgent global public health threat due to its high capacity for person-toperson spread and its ability to produce recalcitrant, drug-resistant infection [1][2][3][4][5]. Since identification in 2009, C. auris has rapidly spread around the world, now accounting for 20% to 30% of Candida bloodstream infections in some healthcare settings [6,7]. Prior to development of invasive disease, C. auris colonizes patients, proliferating on the skin and at other nonsterile sites [4,6].…”