Molecular epidemiology, risk factors, species distribution, antifungal susceptibility and outcome of candidemia in the capital of Iran: a prospective study

Abstract

Background Candidemia is a major cause of morbidity and mortality among patients receiving immunosuppressive therapy and those hospitalized with serious underlying diseases despite the commencement of antifungal therapy. We investigated the molecular epidemiology, clinical characteristics, comorbidity risk factors, species distribution, antifungal susceptibility profile, and outcome of candidemia to provide appropriate perspectives in Tehran, Iran. Methods A prospective observational study of all patients diagnosed with candidemia was performed at two referral teaching hospitals in Tehran. Demographic characteristics, underlying diseases, risk factors, clinical symptoms, and laboratory analyses were mined. Results One-hundred and fifty-two Candida isolates from 89 patients with candidemia were recovered. The overall crude mortality was 47.2%. The most common underlying disease was sepsis (48.3%) followed by malignancy (46.1%), renal failure/ dialysis (43.8%), and Hypertension (40.0%). C. albicans (43.8%) was the most frequent causative agent followed by C. glabrata (21.3%), C. parapsilosis complex (15.7%), C. tropicalis (11.2%), and C. lusitaniae (3.4%). Result of antifungal susceptibility test show that activity of all the four azole antifungal agents was low against non-albicans Candida species, especially C. tropicalis. Conclusion Increase in non-albicans Candida species with reduced susceptibility to antifungal drugs might be alarming in high-risk patients. Therefore, accurate knowledge of predisposing factors and epidemiological patterns in candidemia are effective steps for managing and decreasing the mortality rate in candidemia.