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Factors related to outcome of bloodstream infections due to Candida parapsilosis complex
Francesco Barchiesi1, Elena Orsetti2, Patrizia Osimani3
1Clinica Malattie Infettive; Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I°- G.M. Lancisi - G. Salesi, Ancona, Italy. f.barchiesi@univpm.it.
Background:
Although Candida albicans is the most common cause of fungal blood stream infections (BSIs), infections due to Candida species other than C. albicans are rising. Candida parapsilosis complex has emerged as an important fungal pathogen and became one of the main causes of fungemia in specific geographical areas. We analyzed the factors related to outcome of candidemia due to C. parapsilosis in a single tertiary referral hospital over a five-year period.
Methods:
A retrospective observational study of all cases of candidemia was carried out at a 980-bedded University Hospital in Italy. Data regarding demographic characteristics and clinical risk factors were collected from the patient's medical records. Antifungal susceptibility testing was performed and MIC results were interpreted according to CLSI species-specific clinical breakpoints.
Results:
Of 270 patients diagnosed with Candida BSIs during the study period, 63 (23 %) were infected with isolates of C. parapsilosis complex which represented the second most frequently isolated yeast after C. albicans. The overall incidence rate was 0.4 episodes/1000 hospital admissions. All the strains were in vitro susceptible to all antifungal agents. The overall crude mortality at 30 days was 27 % (17/63), which was significantly lower than that reported for C. albicans BSIs (42 % [61/146], p = 0.042). Being hospitalized in ICU resulted independently associated with a significant higher risk of mortality (HR 4.625 [CI95% 1.015-21.080], p = 0.048). Conversely, early CVC removal was confirmed to be significantly associated with a lower risk of mortality (HR 0.299 [CI95% 0.102-0.874], p = 0.027). Finally, the type of primary antifungal therapy did not influence the outcome of infection.
Conclusions:
Candidemia due to C. parapsilosis complex, the second most commonly causative agent of yeast BSIs in our center, is characterized by a non-negligible mortality at 30 days. An early CVC removal is associated with a significant reduced mortality.
Insights
Candida parapsilosis fungemia is a growing concern, with a 27% mortality rate. Early removal of central venous catheters (CVCs) significantly reduces the risk of death in these patients.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Medicine
Background:
- Invasive fungal infections, particularly candidemia, are a significant cause of morbidity and mortality.
- While Candida albicans is the most common culprit, non-albicans Candida species, including the Candida parapsilosis complex, are emerging pathogens.
- Understanding the epidemiology and outcomes of infections caused by these less common species is crucial for effective patient management.
Purpose of the Study:
- To analyze the factors associated with the outcomes of candidemia caused by the Candida parapsilosis complex.
- To compare the mortality rates of Candida parapsilosis fungemia with those of Candida albicans fungemia.
- To identify independent risk factors for mortality in patients with Candida parapsilosis candidemia.
Main Methods:
- A retrospective observational study was conducted over a five-year period at a tertiary referral hospital.
- Data on demographic characteristics and clinical risk factors were collected from patient medical records.
- Antifungal susceptibility testing was performed, and results were interpreted according to CLSI guidelines.
Main Results:
- Candida parapsilosis complex accounted for 23% of Candida bloodstream infections (BSIs), making it the second most common cause after C. albicans.
- The overall crude mortality at 30 days for C. parapsilosis candidemia was 27%, significantly lower than that for C. albicans BSIs (42%).
- Independent predictors of increased mortality included hospitalization in the intensive care unit (ICU), while early removal of central venous catheters (CVCs) was associated with reduced mortality.
Conclusions:
- Candida parapsilosis complex is a significant cause of candidemia with a considerable 30-day mortality rate.
- Early removal of CVCs is a critical intervention associated with a significant reduction in mortality.
- Antifungal therapy choice did not significantly impact patient outcomes in this study.
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