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https://doi.org/10.1186/s13756-017-0184-1
| Title: | Candidemia in a major regional tertiary referral hospital - epidemiology, practice patterns and outcomes | Authors: | Teo, J.Q.-M Candra, S.R Lee, S.J.-Y Chia, S.Y.-H Leck, H Tan, A.-L Neo, H.-P Leow, K.W.-L Cai, Y Ee, R.P.-L Lim, T.-P Lee, W Kwa, A.L.-H |
Keywords: | amphotericin B anidulafungin caspofungin echinocandin fluconazole flucytosine itraconazole micafungin posaconazole voriconazole adult aged antifungal susceptibility antifungal therapy antimicrobial therapy Article artificial ventilation blood culture bloodstream infection Candida albicans Candida dubliniensis Candida glabrata Candida parapsilosis Candida pseudohaemulonii Candida tropicalis candidemia central venous catheter cerebrovascular disease Charlson Comorbidity Index chronic kidney failure clinical article comorbidity controlled study critically ill patient diabetes mellitus disease surveillance drain female fks gene fungal gene fungus isolation gastrointestinal surgery gene mutation heart infarction hematologic malignancy hepatobiliary disease hospital mortality human immunosuppressive treatment incidence Kluyveromyces marxianus male medical practice Meyerozyma guilliermondii minimum inhibitory concentration neutropenia outcome assessment renal replacement therapy retrospective study risk factor sepsis Simplified Acute Physiology Score Singapore species distribution survival prediction tertiary care center total parenteral nutrition treatment duration very elderly |
Issue Date: | 2017 | Citation: | Teo, J.Q.-M, Candra, S.R, Lee, S.J.-Y, Chia, S.Y.-H, Leck, H, Tan, A.-L, Neo, H.-P, Leow, K.W.-L, Cai, Y, Ee, R.P.-L, Lim, T.-P, Lee, W, Kwa, A.L.-H (2017). Candidemia in a major regional tertiary referral hospital - epidemiology, practice patterns and outcomes. Antimicrobial Resistance and Infection Control 6 (1) : 27. ScholarBank@NUS Repository. https://doi.org/10.1186/s13756-017-0184-1 | Abstract: | Background: Candidemia is a common cause of nosocomial bloodstream infections, resulting in high morbidity and mortality. This study was conducted to describe the epidemiology, species distribution, antifungal susceptibility patterns and outcomes of candidemia in a large regional tertiary referral hospital. Methods: A retrospective surveillance study of patients with candidemia was conducted at Singapore General Hospital between July 2012 and December 2015. In addition, incidence densities and species distribution of candidemia episodes were analysed from 2008 to 2015. Results: In the period of 2012 to 2015, 261 candidemia episodes were identified. The overall incidence was 0.14/1000 inpatient-days. C. glabrata (31.4%), C. tropicalis (29.9%), and C. albicans (23.8%) were most commonly isolated. The incidence of C. glabrata significantly increased from 2008 to 2015 (Coefficient 0.004, confidence interval 0-0.007, p = 0.04). Fluconazole resistance was detected primarily in C. tropicalis (16.7%) and C. glabrata (7.2%). fks mutations were identified in one C. albicans and one C. tropicalis. Candidemia episodes caused by C. tropicalis were more commonly encountered in patients with haematological malignancies (p = 0.01), neutropenia (p < 0.001) and higher SAPS II scores (p = 0.02), while prior exposure to echinocandins was associated with isolation of C. parapsilosis (p = 0.001). Echinocandins (73.3%) were most commonly prescribed as initial treatment. The median (range) time to initial treatment was 1 (0-9) days. The 30-day in-hospital mortality rate was 49.8%. High SAPS II score (Odds ratio, OR 1.08; 95% confidence interval, CI 1.05-1.11) and renal replacement therapy (OR 5.54; CI 2.80-10.97) were independent predictors of mortality, while drain placement (OR 0.44; CI 0.19-0.99) was protective. Conclusions: Decreasing azole susceptibilities to C. tropicalis and the emergence of echinocandin resistance suggest that susceptibility patterns may no longer be sufficiently predicted by speciation in our institution. Candidemia is associated with poor outcomes. Strategies optimising antifungal therapy, especially in the critically-ill population, should be explored. © 2017 The Author(s). | Source Title: | Antimicrobial Resistance and Infection Control | URI: | https://scholarbank.nus.edu.sg/handle/10635/173933 | ISSN: | 20472994 | DOI: | 10.1186/s13756-017-0184-1 |
| Appears in Collections: | Elements Staff Publications |
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