Infection and Drug Resistance (Jul 2023)
Clinical and Microbiological Characteristics of Candidemia Cases in Saudi Arabia
Abstract
Wala Alkhalifa,1 Hassan Alhawaj,1 Aisha Alamri,2 Fatimah Alturki,1 Mohammed Alshahrani,3 Amani Alnimr1 1Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Clinical Laboratory Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Emergency and Critical Care Department, King Fahad Hospital of the University - Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Wala Alkhalifa, 2722 Al Jouri Street, Saihat, Saudi Arabia, Tel +966 551873892, Email [email protected]: Candidemia and antifungal resistance are major healthcare challenges. The aim of this study is to describe the frequency of candidemia cases, distribution of Candida spp., and the associated risk factors for mortality in an academic institution in Saudi Arabia over an 18-month period. We also evaluated the susceptibility patterns of Candida blood isolates.Methods: Candidemia cases were collected from King Fahad Hospital of the University over the period between July 1st, 2020 through December 31st, 2021. They were prospectively reviewed for the preceding risk factors and antifungal (AF) susceptibility, testing results to fluconazole (FL), voriconazole (VO), itraconazole (IT), posaconazole (PO), caspofungin (CASP), anidulafungin (AND), micafungin (MYC), flucytosine (FLC) and amphotericin B (AMPB) using a broth microdilution kit (Sensititre™ YeastOne).Results: A total of 48 candidemia isolates were included that were isolated from 43 patients. The median age of cases was 62 ± 23.3 years (60.4% males and 83% ICU patients). Independent risk factors for mortality at 30 days in candidemia patients were age, COVID-19 co-infection, and use of tocilizumab. The most commonly isolated species were C. glabrata and C. parapsilosis (22.9% each) followed by C. albicans (18.75%). AF resistance for ≥ 1 antifungal was detected in 39.3% of 33 cases tested, with no cross-resistance identified. Resistance rates for each AF were as follows: FL (18%), VO (6%), IT (6%), PO (9%) and AMPB (3%). No resistance was seen for echinocandins apart from one C. krusei strain showing an intermediate result for CASP.Conclusion: The study showed an overall high rate of non-albicans Candida, with the predominance of C. parapsilosis and C. glabrata, representing a therapeutic challenge. AF resistance rate was high which emphasizes the importance of continuing surveillance and providing accurate and reliable tools in the laboratories for rapid speciation and susceptibility testing.Keywords: Candida, candidemia, invasive candidiasis, risk factors, epidemiology, antifungal susceptibility testing
