Clinical characteristics and outcome of candidemia: Experience from a tertiary referral center in Saudi Arabia

Abstract

<b>Background:</b> <i>Candida</i> bloodstream infections cause significant excess morbidity and mortality in the health-care setting. There is limited evidence regarding <i>Candida</i> species causing invasive infections in Saudi Arabia. <b>Objective:</b> To identify <i>Candida</i> species causing bloodstream infection and determine the clinical outcome and factors associated with mortality in a tertiary center in Saudi Arabia. <b>Materials and Methods</b>: This retrospective study included all cases of positive blood culture for <i>Candida</i> in patients admitted to King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia, between January 1, 2013 and June 30, 2019. <b>Results</b>: A total of 532 patients with candidemia were identified (male: 55.4%; mean age: 54 ± 26.2 years). The most common <i>Candida</i> species isolated was <i>Candida albicans</i> (26.7%), followed by <i>Candida glabrata</i> (22.7%), <i>Candida parapsilosis</i> (22.2%), and <i>Candida tropicalis</i> (18.4%). Non-<i>albicans</i> candidemia was more common in patients with diabetes (76.7%; <i>P</i> = 0.0560), neutropenia (89.8%; <i>P</i> = 0.0062), recent exposure to fluconazole (85.7%; <i>P</i> = 0.0394), and active chemotherapy (83.1%; <i>P</i> = 0.0128). In non<i>-albicans</i>, susceptibility to fluconazole varied from 95.9% with <i>C. tropicalis</i> to 41.5% with <i>C. parapsilosis</i>; nonetheless, all species were highly susceptible to echinocandins. The overall 30- and 90-day mortality rates were 39.9% and 56.4%, respectively. The mortality rate was nonsignificantly higher with non-<i>albicans</i> species at 30 days (41.2% vs. 35.9%; <i>P</i> = 0.2634) and 90 days (58.2% vs. 51.4%; <i>P</i> = 0.1620). <b>Conclusion</b>: This study found a changing pattern in the <i>Candida</i> species causing bloodstream infections and an epidemiological shift toward more non-<i>albicans</i> Candida species in Saudi Arabia.