Evolving patterns of candidaemia: contemporary prospective case-control data from 2014-2015

Background:

Over the recent decade, clinical practice has seen an increase in invasive procedures and devices, immunosuppression, antibiotic use, and echinocandin antifungal therapy. We sought to assess current patterns of candidaemia in this context.

Methods:

Fifty-four patients with candidemia (one with recurrence) over 1 year (2014-2015) were matched 1:2 with 110 patient controls for age, admitting team, month of admission and at-risk period at two tertiary Sydney hospitals. Analyses were performed with SPSS software.

Results:

Median age for cases was 61 y (range 20-92) and for controls 64 y (range 19-94). The proven/ suspected source of candidemia were most commonly a central venous catheter (CVC) (49%) and gastrointestinal tract (36%). Overall 36% of 58 isolates were C. albicans and 64% were non-C. albicans. Compared with all candidemia, non-C. albicans episodes showed no significant association with inpatient, outpatient or community-onset, admitting team or prior anti-fungal therapy. An echinocandin was the initial antifungal agent in 47% of episodes (19% C. albicans, 65% non-C. albicans, candidemia). Patients with candidemia were no more likely to have diabetes mellitus, solid organ cancer or organ transplants. Significant predisposing factors in candidemia patients vs. controls included an indwelling urinary catheter (OR 18.4, p < 0.01), CVC (OR 10.2, p < 0.01) and recent surgery (OR 3.7, p 0.01), but not antibiotic use. No risk factors were present in 13% of cases, and no patient co-morbidities in 29%. Prior use of antifungal agents was similar amongst patients and controls. Sepsis (at time of blood culture collection for candidemia patients) was associated with candidaemia (OR 14.4, p < 0.01). Death at </= 30 days occurred in 25% (n=14) of cases of candidemia and 1% (n=1) of controls (OR 36.9, p < 0.01).

Conclusion:

Sepsis was common in candidaemia patients. Over 64% of isolates were non-C. albicans species. Only 33% of candidemia patients had a CVC and13% had no risk factors. Mortality remains high and unchanged in the era of echinocandin therapy.