Antifungal susceptibility, risk factors and treatment outcomes of patients with candidemia at a university hospital in Saudi Arabia

Abstract

Background: Candidemia is a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has been changed especially among critically ill patients due to emergence of non-albicans Candida (NAC) species. The increasing use of azole agents is suggested to be responsible for this epidemiological shift. NAC species are of special concern because of their high drug-resistance and increasing prevalence.The aim of this study was to detect antifungal-susceptibility patterns, treatment outcomes and associated risk factors in patients with candidemia who were admitted to King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) . Methods: This work represents a cross sectional study done in the Clinical and Microbiology Laboratory at KAUH, during the period from March 2012 till February 2014 on a total of 141 patients with candidemia. They were 31(22%) Saudi and 110(87%) non-Saudi patients with age ranged from 1 day - 102 years. Blood cultures were collected for suspected cases of candidemia, followed by subculture on SDA. Identifiation was done by VITEK MS (MALDI-TOF MS), and confimation of Candida isolates and antifungal-susceptibility testing were performed by using VITEK ®2 system. Results: C.albicans isolates accounted for 39.7%, followed by C. tropicalis (21.3%), C. galabrata (18.4%) and C. parapsiliosis (14.9%). Additionally, C. dublinsis, C. krusei and C. famata were representing 2.1%, 2.1% and 1.4%, respectively. All Candida isolates were 100% susceptible to amphotericin B. The best susceptibility to flconazole was detected among each C. dubliensis and C. famata (100%). All C. krusei isolates were resistant to flconazole, while they were susceptible  to other antifungal agents. All isolates were susceptible to flcytosine,except C. albicans and C. dubliensis which were susceptible 92.9%and 66.7%, respectively. All isolates were susceptible to itraconazol,except C. albicans and C. tropicalis which were susceptible 94.6% and 96.7%, respectively. The percentage of deceased patients with candidemia was signifiantly higher than the survivors among age group >64 years, particularly those who were mechanically ventilated and those understeroid therapy. The percentage of deceased patients was signifiantly higher than survivors among those admitted to adult ICUs (73.78%vs 26.23%) . Conclusion: This study shows an epidemiological shift to higher NAC species isolation rates, with 100% susceptibility to amphotericin B in all isolates either C. albicans or NAC species, and 100% susceptibility to flconazole among C. dubliensis and C. famata. Patients aged > 64 years, admission to adult ICUs, mechanical ventilation and steroid therapy were signifiant risk factors for increased mortality due to candidemia.