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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Antimicrobial Resistance & Infection Control 1/2017

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

Zeitschrift:
Antimicrobial Resistance & Infection Control > Ausgabe 1/2017
Autoren:
Jocelyn Qi-Min Teo, Samuel Rocky Candra, Shannon Jing-Yi Lee, Shannon Yu-Hng Chia, Hui Leck, Ai-Ling Tan, Hui-Peng Neo, Kenneth Wei-Liang Leow, Yiying Cai, Rachel Pui-Lai Ee, Tze-Peng Lim, Winnie Lee, Andrea Lay-Hoon Kwa
Wichtige Hinweise
A correction to this article is available online at https://​doi.​org/​10.​1186/​s13756-018-0413-2.

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.
Literatur
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