Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Candidemia is a common cause of nosocomial bloodstream infections, resulting in high morbidity and mortality. This study was conducted to describe the epidemiology, species distribution, antifungal susceptibility patterns and outcomes of candidemia in a large regional tertiary referral hospital.

Methods

A retrospective surveillance study of patients with candidemia was conducted at Singapore General Hospital between July 2012 and December 2015. In addition, incidence densities and species distribution of candidemia episodes were analysed from 2008 to 2015.

Results

In the period of 2012 to 2015, 261 candidemia episodes were identified. The overall incidence was 0.14/1000 inpatient-days. C. glabrata (31.4%), C. tropicalis (29.9%), and C. albicans (23.8%) were most commonly isolated. The incidence of C. glabrata significantly increased from 2008 to 2015 (Coefficient 0.004, confidence interval 0–0.007, p = 0.04). Fluconazole resistance was detected primarily in C. tropicalis (16.7%) and C. glabrata (7.2%). fks mutations were identified in one C. albicans and one C. tropicalis. Candidemia episodes caused by C. tropicalis were more commonly encountered in patients with haematological malignancies ( p = 0.01), neutropenia ( p < 0.001) and higher SAPS II scores ( p = 0.02), while prior exposure to echinocandins was associated with isolation of C. parapsilosis ( p = 0.001). Echinocandins (73.3%) were most commonly prescribed as initial treatment. The median (range) time to initial treatment was 1 (0–9) days. The 30-day in-hospital mortality rate was 49.8%. High SAPS II score (Odds ratio, OR 1.08; 95% confidence interval, CI 1.05–1.11) and renal replacement therapy (OR 5.54; CI 2.80–10.97) were independent predictors of mortality, while drain placement (OR 0.44; CI 0.19–0.99) was protective.

Conclusions

Decreasing azole susceptibilities to C. tropicalis and the emergence of echinocandin resistance suggest that susceptibility patterns may no longer be sufficiently predicted by speciation in our institution. Candidemia is associated with poor outcomes. Strategies optimising antifungal therapy, especially in the critically-ill population, should be explored.

Related collections

Most cited references 16

Record: found
Abstract: found
Article: not found

Anidulafungin versus fluconazole for invasive candidiasis.

Annette Reboli, Coleman Rotstein, Peter Pappas … (2007)

Anidulafungin, a new echinocandin, has potent activity against candida species. We compared anidulafungin with fluconazole in a randomized, double-blind, noninferiority trial of treatment for invasive candidiasis. Adults with invasive candidiasis were randomly assigned to receive either intravenous anidulafungin or intravenous fluconazole. All patients could receive oral fluconazole after 10 days of intravenous therapy. The primary efficacy analysis assessed the global response (clinical and microbiologic) at the end of intravenous therapy in patients who had a positive baseline culture. Efficacy was also assessed at other time points. Eighty-nine percent of the 245 patients in the primary analysis had candidemia only. Candida albicans was isolated in 62% of the 245 patients. In vitro fluconazole resistance was infrequent. Most of the patients (97%) did not have neutropenia. At the end of intravenous therapy, treatment was successful in 75.6% of patients treated with anidulafungin, as compared with 60.2% of those treated with fluconazole (difference, 15.4 percentage points; 95% confidence interval [CI], 3.9 to 27.0). The results were similar for other efficacy end points. The statistical analyses failed to show a "center effect"; when data from the site enrolling the largest number of patients were removed, success rates at the end of intravenous therapy were 73.2% in the anidulafungin group and 61.1% in the fluconazole group (difference, 12.1 percentage points; 95% CI, -1.1 to 25.3). The frequency and types of adverse events were similar in the two groups. The rate of death from all causes was 31% in the fluconazole group and 23% in the anidulafungin group (P=0.13). Anidulafungin was shown to be noninferior to fluconazole in the treatment of invasive candidiasis. (ClinicalTrials.gov number, NCT00056368 [ClinicalTrials.gov]). Copyright 2007 Massachusetts Medical Society.

0 comments Cited 178 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004-2008.

Michael Pfaller, Dionissios Neofytos, Daniel Diekema … (2012)

This analysis describes the epidemiology and outcomes of candidemia in patients enrolled in the Prospective Antifungal Therapy Alliance (PATH Alliance®) registry from 2004 to 2008. Overall, 4067 Candida isolates were identified from 3648 patients. The most common Candida spp. were C. albicans (42.1%), C. glabrata (26.7%), C. parapsilosis (15.9%), C. tropicalis (8.7%), and C. krusei (3.4%). The proportion of candidemia caused by non-albicans Candida spp. (57.9%) was higher than that caused by C. albicans (42.1%). Infections with C. albicans were most common in neonatal intensive care unit (54.8%). In total, 3342 patients received antifungal therapy; fluconazole (66.0%) and echinocandins (50.5%) were most frequently administered. The 90-day survival rate for all patients was 61.3%. Among the most common Candida spp., the highest 90-day survival rate was observed for C. parapsilosis (70.0%) and the lowest for C. krusei (53.6%). In conclusion, this study expands the current knowledge of the epidemiology and outcomes of candidemia. Copyright © 2012 Elsevier Inc. All rights reserved.

0 comments Cited 125 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Declining Incidence of Candidemia and the Shifting Epidemiology of Candida Resistance in Two US Metropolitan Areas, 2008–2013: Results from Population-Based Surveillance

Angela Ahlquist Cleveland, Lee Harrison, Monica Farley … (2015)

Background Recent reports have demonstrated a decline in bacterial bloodstream infections (BSIs) following adherence to central line insertion practices; however, declines have been less evident for BSIs due to Candida species. Methods We conducted active, population-based laboratory surveillance for candidemia in metropolitan Atlanta, GA and Baltimore, MD over a 5-year period. We calculated annual candidemia incidence and antifungal drug resistance rates. Results We identified 3,848 candidemia cases from 2008–2013. Compared with 2008, candidemia incidence per 100,000 person-years decreased significantly by 2013 in both locations (GA: 14.1 to 9.5, p<0.001; MD: 30.9 to 14.4, p<0.001). A total of 3,255 cases (85%) had a central venous catheter (CVC) in place within 2 days before the BSI culture date. In both locations, the number of CVC-associated cases declined (GA: 473 to 294; MD: 384 to 151). Candida albicans (CA, 36%) and Candida glabrata (CG, 27%) were the most common species recovered. In both locations, the proportion of cases with fluconazole resistance decreased (GA: 8.0% to 7.1%, −10%; MD: 6.6% to 4.9%, −25%), while the proportion of cases with an isolate resistant to an echinocandin increased (GA: 1.2% to 2.9%, +147%; MD: 2.0% to 3.5%, +77%). Most (74%) echinocandin-resistant isolates were CG; 17 (<1%) isolates were resistant to both drug categories (multidrug resistant [MDR], 16/17 were CG). The proportion of CG cases with MDR Candida increased from 1.8% to 2.6%. Conclusions We observed a significant decline in the incidence of candidemia over a five-year period, and increases in echinocandin-resistant and MDR Candida. Efforts to strengthen infection control practices may be preventing candidemia among high-risk patients. Further surveillance for resistant Candida is warranted.

0 comments Cited 106 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Jocelyn Qi-Min Teo: jocelyn.teo.q.m@sgh.com.sg

Samuel Rocky Candra: samuel.rocky.candra@sgh.com.sg

Shannon Jing-Yi Lee: shannon.lee.l.h@sgh.com.sg

Shannon Yu-Hng Chia: shannon_YH_CHIA@ttsh.com.sg

Hui Leck: leck.hui@sgh.com.sg

Ai-Ling Tan: tan.ai.ling@sgh.com.sg

Hui-Peng Neo: neo.hui.peng@sgh.com.sg

Kenneth Wei-Liang Leow: kenneth.leow.w.l@sgh.com.sg

Yiying Cai: cai.yiying@sgh.com.sg

Rachel Pui-Lai Ee: phaeplr@nus.edu.sg

Tze-Peng Lim: lim.tze.peng@sgh.com.sg

Winnie Lee: winnie.lee.l.h@sgh.com.sg

Andrea Lay-Hoon Kwa: +65 63213401 , andrea.kwa.l.h@sgh.com.sg

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 11 March 2017

Publication date PMC-release: 11 March 2017

Publication date Collection: 2017

Volume: 6

Electronic Location Identifier: 27

Affiliations

[1 ]ISNI 0000 0000 9486 5048, GRID grid.163555.1, Department of Pharmacy, , Singapore General Hospital, ; Blk 8 Level 2, Outram Road, Singapore, 169608 Singapore

[2 ]ISNI 0000 0000 9486 5048, GRID grid.163555.1, Department of Microbiology, , Singapore General Hospital, ; Outram Road, Singapore, 169608 Singapore

[3 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, Department of Pharmacy, , National University of Singapore, ; 18 Science Drive 4, Singapore, 117543 Singapore

[4 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, , SingHealth Duke-NUS Medicine Academic Clinical Programme, ; 20 College Rd, Singapore, 169856 Singapore

[5 ]ISNI 0000 0004 0385 0924, GRID grid.428397.3, Emerging Infectious Diseases, , Duke-NUS Medical School, ; 8 College Rd, Singapore, 169857 Singapore

[6 ]GRID grid.240988.f, , Present address: Tan Tock Seng Hospital, ; 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore

Article

Publisher ID: 184

DOI: 10.1186/s13756-017-0184-1

PMC ID: 5346229

PubMed ID: 28293420

SO-VID: 55b60469-dec1-4b0f-8763-3d9a318028ed

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 August 2016

Date accepted : 16 February 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001349, National Medical Research Council;

Award ID: NMRC/TA/0025/2013

Award ID: NMRC/CG/016/2013

Funded by: Pfizer (US)

Award ID: WS2347894

Funded by: FundRef http://dx.doi.org/10.13039/501100001469, Singapore General Hospital;

Award ID: SRG #15/20

Award Recipient : Winnie Lee

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: candida,bloodstream infections,antifungal susceptibility,fks,mortality

Data availability:

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: candida, bloodstream infections, antifungal susceptibility, fks, mortality

Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes

Read this article at

Abstract

Background

Methods

Results

Conclusions

Related collections

SDG 3: Good Health and Well-Being

Most cited references 16

Anidulafungin versus fluconazole for invasive candidiasis.

Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004-2008.

Declining Incidence of Candidemia and the Shifting Epidemiology of Candida Resistance in Two US Metropolitan Areas, 2008–2013: Results from Population-Based Surveillance

Author and article information

Contributors

Journal

Affiliations

Article

History

Funding

Categories

Custom metadata

Comments

Comment on this article

Similar content 119

Cited by 11

Most referenced authors 567