Please use this identifier to cite or link to this item: 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
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