Antifungal susceptibility, risk factors and treatment outcomes of patients with candidemia at a university hospital in Saudi Arabia
Keywords:Candidemia, Non- albicans Candida, Antifungal susceptibility
Background: Candidemia is a major cause of morbidity and mortality inÂ hospitalized patients. The spectrum of candidemia has been changedÂ especially among critically ill patients due to emergence of non-albicansÂ Candida (NAC) species. The increasing use of azole agents is suggestedÂ to be responsible for this epidemiological shift. NAC species are ofÂ special concern because of their high drug-resistance and increasingÂ prevalence.The aim of this study was to detect antifungal-susceptibilityÂ patterns, treatment outcomes and associated risk factors in patientsÂ 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 theÂ Clinical and Microbiology Laboratory at KAUH, during the period
from March 2012 till February 2014 on a total of 141 patients withÂ candidemia. They were 31(22%) Saudi and 110(87%) non-SaudiÂ patients with age ranged from 1 day - 102 years. Blood cultures wereÂ collected for suspected cases of candidemia, followed by subcultureÂ on SDA. Identifiation was done by VITEK MS (MALDI-TOF MS), andÂ confimation of Candida isolates and antifungal-susceptibility testingÂ were performed by using VITEK Â®2 system.
Results: C.albicans isolates accounted for 39.7%, followed by C.Â tropicalis (21.3%), C. galabrata (18.4%) and C. parapsiliosis (14.9%).Â Additionally, C. dublinsis, C. krusei and C. famata were representingÂ 2.1%, 2.1% and 1.4%, respectively. All Candida isolates were 100%Â susceptible to amphotericin B. The best susceptibility to flconazoleÂ was detected among each C. dubliensis and C. famata (100%). All C.Â krusei isolates were resistant to flconazole, while they were susceptible Â 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 NACÂ species isolation rates, with 100% susceptibility to amphotericin B inÂ all isolates either C. albicans or NAC species, and 100% susceptibilityÂ to flconazole among C. dubliensis and C. famata. Patients aged >Â 64 years, admission to adult ICUs, mechanical ventilation and steroidÂ therapy were signifiant risk factors for increased mortality due toÂ candidemia.
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