A single-centre 10-year experience with Candida bloodstream infections

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Microbiology

Background:

• Candida bloodstream infections (candidemia) are a significant cause of morbidity and mortality.
• Understanding the epidemiology and antifungal susceptibility patterns of Candida species is crucial for effective treatment.

Purpose of the Study:

• To characterize the clinical and microbiological features of Candida bloodstream infections.
• To assess antifungal susceptibility trends over a ten-year period at Hôpital Maisonneuve-Rosemont.

Main Methods:

• Retrospective review of patient episodes and microbiology laboratory data.
• Antifungal susceptibility testing using the Clinical and Laboratory Standards Institute's M27A2 method.

Main Results:

• 190 candidemia episodes were identified; Candida albicans was the most frequent species (57%).
• Central venous catheters were present in 88% of patients.
• Resistance to fluconazole was observed in 14% of isolates, significantly higher in non-albicans Candida species (27%) compared to C. albicans (4%).
• Hematology-oncology unit admission and recent azole antifungal use were associated with fluconazole resistance.

Conclusions:

• Candida bloodstream infection epidemiology and species distribution remained stable over the decade.
• In vitro resistance to fluconazole and itraconazole in C. albicans was minimal.
• Non-albicans Candida species showed increasing, though not statistically significant, resistance to fluconazole.
• Newer antifungal agents demonstrated high in vitro activity against bloodstream Candida isolates.