Epidemiology, antifungal susceptibilities, and risk factors for invasive candidiasis from 2011 to 2013 in a teaching hospital in southwest China

Abstract

Background: Invasive candidiasis (IC) is the most common cause of invasive fungal infections. Identification of risk factors for such infection may help in the empirical therapeutic decision-making process. We conducted this study to characterize the clinical epidemiology of such infection and to differentiate risk factors between Candida albicans and Candida non-albicans species.

Methods: We retrospectively evaluated patients with IC from 2011 to 2013. Clinical data, antibiotic therapy, underlying condition, and invasive procedures were analyzed and compared between C. albicans and C. non-albicans species.

Results: C. albicans was the most frequently isolated Candida species (48.6% of all IC patients), although C. non-albicans spp. were more commonly isolated overall. C. albicans, Candida tropicalis, and Candida parapsilosis have a high susceptibility rate to all antifungal agents (>90%), whereas Candida glabrata showed decreased susceptibility to fluconazole and itraconazole. Amphotericin B demonstrated excellent antifungal activity against all Candida species. Univariate analyses showed that IC patients with C. albicans had a higher ratio of older age (p = 0.008), solid tumor (p = 0.029), and hypoproteinemia (p = 0.019), whereas those with C. non-albicans spp. had a higher ratio of hospital length of stay (p = 0.005), usage of corticosteroids (p = 0.011), duration on corticosteroids (p = 0.005), chemotherapy (p = 0.022), hematologic malignancy (p = 0.039), neutropenia (p = 0.030), and usage of glycopeptides (p = 0.002). Multivariate analyses showed that a significant predictor of IC due to C. albicans was hypoproteinemia [odds ratio (95% confidence interval) = 2.133 (1.164-3.908), p = 0.014].

Conclusion: C. albicans was the most frequently isolated Candida species. The risk factors between C. albicans and C. non-albicans species are different.

Keywords: Antifungal susceptibility; Epidemiology; Invasive candidiasis; Risk factor.