Candidemia at a University Hospital: epidemiology, risk factors and predictors of mortality

Blood stream infection due to candida species are becoming increasingly important causes of morbidity and mortality in hospitalized patients. The aim of this study was to obtain epidemiological data on candidemia in patients at King Abdulaziz University Hospital (KAUH), and to discuss the influence of several clinical variables on the development and outcome of candidemia.

Demographic information, risk factors, therapy and outcome of all patients who had candidemia at KAUH between January 1998 and December 1999 were reviewed.

Thirty-one candidemic episodes were identified. All the candidemic episodes were hospital acquired. The most common risk factors to candidemia were central venous catheters (87%), stay in intensive care unit (ICU) (77%), and broad-spectrum antibiotics therapy (74%). Candida albicans was the most frequently isolated species (71%), followed by candida tropicalis and candida parapsilosis (13% each). Twenty-six patients (84%) were treated with amphotericin B, 4 (13%) with fluconazole, and one (3%) with ketoconazole. Antifungal susceptibility testing of the isolates in general revealed minimal levels of resistance to amphotericin B (3%) versus 39% resistance to fluconazole. Less than 5% of Candida albicans were resistant to amphotericin B, in comparison with >35% of these strains that were resistant to fluconazole. The overall mortality was 71%. Mortality was significantly associated with the presence of central venous catheters (P=0.001), stay in intensive care unit (P<0.001), and prolonged hospital stay before the onset of candidemia (P=0.05).

Despite antifungal treatment, the mortality of candidemia is still high. Rapid changes in the rate of infection, potential risk factors, and emerging species demand continued and close surveillance of this serious infection.