Background: Candidemia is the 4th most common cause of nosocomial BSI in the US and is associated with high mortality. A multicenter surveillance study conducted in the US from 2004-08 reported 54% of Candidemia was caused by non-albicans species (C. glabrata 26%, C. parapsilosis 16%). The aim of this study was to evaluate the epidemiology, risk factors, species identification, susceptibility and complications associated with Candidemia.
Methods: We conducted a retrospective analysis of demographic data, species identification, antifungal susceptibility and complications associated with Candidemia at St. Louis University Hospital between Jan 2009 to June 2013. An episode of Candidemia was defined as at least one positive blood culture during a single hospitalization
Results: 96/103 met the inclusion criteria. Avg age at diagnosis was 54.5 yrs and 60.2% were males. The avg duration of ICU stay and total length of stay was 15.8 and 26.4 days respectively. The major risk factors were broad spectrum antibiotics 87/96 (91%) and CVC 71/96 (74%). 103 Candida species were isolated from 96 patients of which non-albicans species was the most common 66/103 (64.1%) followed by albicans 37/103 (35.9%). The most common non-albicans species was C.glabrata (31%) followed by C.tropicalis (11.6%) and C.parapsilosis (6.7%). All cause mortality was 33/96 (34.3%) and 12/33 (36.3%) were fungemic at the time of death. Majority of the isolates were susceptible to fluconazole and caspofungin. ID was consulted for 78/96 (81.25%) cases. Ophthalmology was consulted for 72/96 (75%). 6/72 (8.3%) were diagnosed with Candida endophthalmitis and C.albicans was isolated from 4/6 (66.6%). 7/96 (7.3%) had Candida endocarditis and C.albicans was isolated from 4/7 (57.1%). 18/54(33.3%) CVC tip cultures grew Candida.
Conclusion: Candidemia is associated with high mortality. The major predisposing factors were broad spectrum antibiotics and central venous catheters. The majority of Candida isolates were non-albicans species, of which the most common was C.glabrata followed by C.tropicalis. The majority of the isolates were susceptible to fluconazole and caspofungin. The most common species isolated from patients with complications like endophthalmitis and endocarditis was C.albicans.
Minh Ho, DO1, Sowmya Nanjappa, MD2, Mohammed Alhassen, MD3, Ganesh Gajanan, MBBS2, Chandrashekar Bohra, MBBS2 and John Greene, MD, FACP, FSHEA2, (1)Infectious Diseases and International Medicine, University of South Florida, Tampa, FL, (2)Moffitt Cancer Center, Tampa, FL, (3)Banner medical group ID, Phoenix, AZ
None M. Alhassen,
None G. Gajanan,
None C. Bohra,
None J. Greene,