Candidemia in a Portuguese tertiary care hospital: Analysis of a 2-year period - 21/08/19

Doi : 10.1016/j.mycmed.2019.08.002

S. Pinto-Magalhães ^a,⁎ , A. Martins ^a,^b, S. Lacerda ^a,^b, R. Filipe ^a,^b, B. Prista-Leão ^a,^b, D. Pinheiro ^c, A. Silva-Pinto ^a,^b, L. Santos ^a,^b
^a Faculty of Medicine of the University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
^b Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
^c Microbiology Laboratory, Clinical Pathology Department, Centro Hospitalar Universitário de São João, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal

^⁎Corresponding author.

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Abstract

Background

Candidemia is a nosocomial infection of increasing importance, associated with high morbidity and mortality. The aim of this study is to describe the species distribution, risk factors, management and outcomes of patients with candidemia.

Methods

We conducted a retrospective study at Centro Hospitalar Universitário de São João, Portugal, between January 2016 and December 2017.

Results

A total of 117 candidemia episodes (n=114 patients) were included. Median age was 65 years, with an increased prevalence of older ages. Candida albicans (51.3%) was the most prevalent species, followed by C. glabrata (22.2%), C. parapsilosis (15.4%), C. tropicalis (4.3%) and C. lusitaniae (2.6%). Forty-two patients (35.9%) did not receive antifungal drugs after diagnosis of candidemia. Echinocandins were used as first-line drug therapy in half of the treated patients (50.7%). The median EQUAL Candida Score was 6/17 (IQR 6-9) for patients without central venous catheter (CVC) and 11/20 (IQR 6-14) for patients with CVC. The 30 days-mortality was 31,6% and was not significantly associated with the timing of antifungal therapy and the EQUAL Candida Score.

Conclusion

The distribution of Candida species has changed in recent years, with an increase in the proportion of C. albicans and C. glabrata. Rapid diagnostic tests, empiric antifungal therapy and source control are essential to improve the prognosis of patients with candidemia. More multicentric prospective studies are needed to evaluate the association of mortality with the timing of antifungal therapy or the EQUAL Candida Score.

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Keywords : Candida species, Candidemia, EQUAL Candida Score

Abbreviations : Invasive candidiasis, Central venous catheter, Infectious Diseases Society of America, European Society for Clinical Microbiology and Infectious Diseases, Interquartile range, Intensive care units