Epidemiology, clinical characteristics, and outcome in candidemia: a retrospective five-year analysis from two tertiary general hospitals

Abstract

Abstract Background Candidemia is linked with high mortality, highlighting the critical importance of timely empirical antimicrobial therapy and precise medical intervention before a definite etiologic diagnosis. The current study aimed to investigate the prevalence of pathogens in patients with candidemia and evaluate the potential independent risk factors for Candida albicans bloodstream infections (BSI), as well as the prognosis of candidemia. Methods A retrospective bicentric observational study was performed, incorporating 132 candidemia episodes from two tertiary general hospitals in the Linyi area between January 2019 and December 2023. Data on demographic characteristics, underlying diseases, medical intervention, and antimicrobial sensitivity were collected and analyzed using SPSS version 27.0. Univariate analysis and binary logistic regression analyses were performed to identify risk factors for non-albicans Candida infections and candidemia-related mortality. Results A total of 132 strains of Candida species were isolated from 132 patients with candidemia, with non-albicans Candida accounting for 71.97% (95/132) and Candida albicans for 28.03%. Although Candida albicans remains the predominant species, the proportion of Candida tropicalis, mainly from the Hematology Ward, is approaching that of Candida albicans, which was mainly found in the intensive care unit (ICU) (27.27% versus 28.03%). Moreover, Candida tropicalis, the most frequently isolated non-albicans Candida species, exhibited poorer sensitivity to triazole drugs than other Candida species. Multivariate analysis identified gastrointestinal surgery (non-tumor) as an independent risk factor for Candida albicans BSI (odds ratio [OR] = 6.683, 95% confidence interval [CI]: 1.253–35.632, P = 0.026). The 30-day mortality rate of candidemia in the current study was 30.3%. Binary logistic regression analysis identified several factors significantly associated with mortality, including age (OR = 1.038, 95% CI: 1.007–1.071, P = 0.018) and septic shock (OR = 3.307, 95% CI: 1.205–9.071, P = 0.020). Conclusion The mortality rate of candidemia in the current study reached 30.3%, indicating a high disease burden. Recently, the proportion of non-albicans Candida, especially Candida tropicalis, has increased markedly. Therefore, increased attention should be given to patients with the identified risk factors to improve candidemia management and outcomes. Clinical trial number Not applicable.

Keywords

• Candidemia
• Candida species
• Antifungal susceptibility
• Mortality
• Risk factors