Epidemiology and Species Distribution of Candida Bloodstream Infections in a Comprehensive Cancer Center, 2008-2023

Candida bloodstream infections remain a significant complication of malignancies and their therapies.

To investigate the epidemiology of Candida species causing bloodstream infections in patients with malignancies.

We retrospectively reviewed bloodstream infections due to Candida from July 2008 to June 2023 in patients admitted under hematological, solid tumor and surgical services. Common species included C. albicans, Nakaseomyces glabratus (formerly C. glabrata), Pichia kudriavzevii (formerly C. krusei), C. parapsilosis complex and C. tropicalis. The rest were classified as uncommon.

Incidence of candidemia was 0.46 episodes per 1,000 patients-days of admission. Of 265 episodes of candidemia, 102 (38.5%) occurred in patients under hematological services, 59 (22.3%) under solid tumor and 104 (39.2%) under surgical services. Among 271 available isolates, C. albicans was the predominant species, accounting for 96 (35.4%). N. glabratus (formerly C. glabrata) was the dominant species in 15 (55.6%) episodes of candidemia following triazole exposure (p: 0.008) and C. parapsilosis the dominant in 15 (34.9%) following echinocandin exposure (p: < .001). Candidemia due to uncommon Candida species occurred in 22 (8.3%) episodes for the total cohort and in 17 (16.7%) in patients with hematological malignancies (p: < .001). Multivariable logistic regression analysis identified neutropenia (OR 4.5 [95% CI 1.7-11.9]) as independent predictor of candidemia caused by uncommon species.

Candidemia due to uncommon species occurred with higher frequency in patients with malignancies, with the highest rates observed among those with hematological malignancies.