626. Epidemiology of Candidemia and Factors Associated with Candidemia Caused by Non-Albicans Candida Species: An 8-Year Experience of a Thai University Hospital
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: : Candidemia is one of the major causes of nosocomial infection. A significant shift from Candida albicans (C. albicans) to non-albicans Candida spp. was observed worldwide. We aim to evaluate the epidemiology of candidemia and identify factors associated with non-albicans Candida spp. in Thailand.

Methods: : We retrospectively reviewed medical and microbiological data of patients with candidemia who were admitted at Ramathibodi Hospital from 2002-2009.

Results: : A total of 403 isolates of candidemia were determined. C. albicans was recovered in 40.9%, followed by C. tropicalis 29%, C. glabrata 13.9%, C. parapsilosis 10.4%, C. gullermondii 4%, and others 1.7%. During the 8-year period, the proportion of candidemia caused by non-albicans Candida spp. was higher than 50% each year and there was no significant increase in a trend (p = 0.310). Clinical characteristics of 86 and 94 patients with C. albicans and non-albicans Candida spp. infection were reviewed. Mean (SD) age was 62.8 (15.6) years and 51.1% were male. Major underlying disease included solid malignancy (43.9%), hematologic malignancy (15.6%), and diabetes mellitus (13.3%). Other associated factors were central venous catheter (80.0%), broad-spectrum antibiotic (62.8%), and steroid exposure (61.1%). By multivariate analysis, antifungal agent exposure (OR 4.62; 95% CI 0.91-23.39), neutropenia (OR 4.56; 95% CI 0.87-23.43), intensive care unit (ICU) admission (OR 1.97; 95% CI 1.04-371), and steroid exposure (OR 0.64; 95% CI 0.42-0.97) were associated with candidemia caused by non-albicans Candida spp. Approximately 42% were admitted in ICU. Overall mortality rate was 51.7%.        

Conclusion: : Candidemia caused by non-albicans Candida spp. seems to be predominant. Knowing the predicting factors may help physicians guide appropriate initial antifungal therapy which is essentially required in order to decrease morbidity and mortality.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Sasisopin Kiertiburanakul, MD, MHS , Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Wootthisak Areewattananon, MD , Dep of Medicine, Div of Infectious Diseases, Fac of Medicine Ramathibodi Hospital, Bangkok, Thailand
Piriyaporn Chongtrakool, PhD , Dep of Medicine, Div of Infectious Diseases, Fac of Medicine Ramathibodi Hospital, Bangkok, Thailand
Yuda Sutherasan, MD , Dep of Medicine, Div of Infectious Diseases, Fac of Medicine Ramathibodi Hospital, Bangkok, Thailand
Siriorn P. Watcharananan, MD , Dep. of Medicine, Mahidol University; Ramathibodi Hospital, Bangkok, Thailand

Disclosures:

S. Kiertiburanakul, None

W. Areewattananon, None

P. Chongtrakool, None

Y. Sutherasan, None

S. P. Watcharananan, None

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