Navigating Candidemia in a tertiary hospital: A 4-year epidemiologic and clinical review

This study describes the epidemiology, risk factors, therapeutic management, antifungal resistance patterns, and clinical outcomes of candidemia in hospitalized patients. It also examines predictors of 30-day mortality and factors associated with Candida albicans (CA) vs non-albicans Candida (NCA) infections.

A retrospective review was conducted at a tertiary care center in Lebanon (2017-2021). Clinical, microbiological, and treatment data were extracted from medical records. Statistical analyses were performed to identify factors associated with 30-day mortality and the occurrence of CA vs NCA species.

A total of 98 candidemia episodes in 93 patients were analyzed. CA and NCA species were equally represented (50% each). Resistance was highest to fluconazole and itraconazole (7.3%). The 30-day mortality rate was 38.8%. Factors significantly associated with increased mortality included intensive care unit admission (odds ratio [OR] 7.42), chronic renal failure (OR 7.29), dialysis (OR 7.28), mechanical ventilation (OR 4.71), and central venous catheters (OR 10.91). Catheter removal was protective (OR 0.205, P = 0.002). NCA infections were associated with dyslipidemia (OR 3.33) and multiple previous hospitalizations (OR 3.65).

Antifungal resistance remains relatively low in this cohort; however, candidemia continues to carry a high mortality rate. Optimizing management through adherence to international guidelines and specialist oversight is essential to improve outcomes and address the diverse clinical presentations of CA and NCA infections.