Epidemiology, Risk Factors and Clinical Outcome of Candidaemia: A decade-long experience at a university hospital in Oman

TL;DR

A decade-long study in Oman found that non-albicans Candida species are increasingly causing candidaemia, with diabetes as a major risk factor and high mortality rates.

Contribution

The study provides updated epidemiological data on candidaemia in Oman, highlighting rising non-albicans species and risk factors like diabetes.

Findings

Candida albicans was the most common species, but non-albicans species like Nakaseomyces glabrata were increasingly prevalent.

Diabetes mellitus was the most frequently identified risk factor for candidaemia.

Mortality rates were unacceptably high at 53.3%, with a need for improved antifungal therapy initiation.

Abstract

This study aimed to examine a decade-long epidemiology of candidaemia to explore the risk factors associated with it, and describe its clinical outcomes in hospitalised adult patients.

This retrospective observational study was conducted at Sultan Qaboos University Hospital, Muscat, Oman. Adult patients with candidaemia hospitalised between January 2007 and December 2016 were included. The hospital infection control department surveillance registry on bloodstream infections (BSIs) was used to identify Candida BSIs. Patients' electronic medical records were searched for demographic characteristics, clinical risk factors and outcomes.

Candida albicans was the most common Candida species among 152 patients with candidaemia comprising 25.0% of all Candida blood culture isolates. Nakaseomyces glabrata, C. tropicalis and C. parapsilosis were the most frequently isolated non-albicans species. Past antibiotics use, presence of central venous catheters, intensive care unit admission, diabetes mellitus, sickle cell disease and solid cancer were the most commonly identified underlying risk factors for candidaemia. A total of 30 days' all-cause mortality was 53.3% among all patients with candidaemia.

This study found an increasing trend of non-albicans Candida. Diabetes was the most identified risk factor for candidaemia. A relatively low rate of initiation of empirical antifungal therapy in at-risk patients was found. Unacceptably high mortality rates and prolonged hospital stay of patients with candidaemia are a call for action.

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