Candida sake candidaemia in non-neutropenic critically ill patients: a case series

Candida sake infections are rare, but have been shown to cause severe infections including fungal endocarditis, peritonitis and bloodstream infection. As the reported incidence of C. sake candidaemia is very low, there is a dearth of data regarding the associated risk factors, antifungal agent-susceptibility patterns, optimal treatment policies, clinical course and outcomes of patients with such infections. We report a series of seven non-neutropenic intensive care unit patients with C. sake candidaemia. Most of the patients were men (6/7), were over 65 years of age (5/7) and had a history of recent hospitalisation (4/7) and comorbidities (4/7). However, all seven patients had a previous history of antibiotic uptake for more than 5 days and had a central venous catheter in situ at the time of taking specimens for culture. In four patients, infection was azole-resistant. Four patients required vasopressor support, three required mechanical ventilation and two required renal replacement therapy. Three of the seven patients died. This case series emphasises the importance of performing species identification and antifungal susceptibility testing in ICU patients with candidaemia, especially those with advanced age, underlying chronic diseases, indwelling vascular catheters, or a history of previous antibiotics or recent hospitalisations, as these patients may be at an increased risk of developing rare Candida infections like C. sake. Moreover, these rare Candida species may be more frequently resistant to azole antifungal agents, and may be associated with significant mortality.