Ten-Year Review of Candidemia in a Canadian Tertiary Care Centre: Predominance of Non-albicans CandidaSpecies

Abstract

OBJECTIVE: To review the epidemiology and associated risk factors for candidemia at a tertiary care centre, in view of recent reports on the changing epidemiology of bloodstream infection due toCandidaspecies.METHODS: Between January 2000 and December 2009, patients with blood culture samples positive forCandidaspecies were identified using the microbiology laboratory information system. Patient data were collected by retrospective chart review of clinical characteristics including demographic data, underlying medical diagnoses and risk factors.RESULTS: A total of 266 candidemia episodes were included in the final analysis. Fifty-nine per cent of these episodes occurred in males and 51% were in patients >60 years of age. The most common risk factor for candidemia was previous antibiotic use (85%). The most frequent species wasCandida albicans(49%), followed byCandida glabrata(30%).C albicanswas the predominant species in all study years with the exception of 2002, in whichC glabratawas more frequent. The likelihood of recovering a non-albicans Candidaspecies was found to be significantly associated with previous antifungal therapy (P=0.0004), immunosuppressive therapy (P=0.002), abdominal surgery (P=0.003) and malignancy (P=0.05). Mixed candidemia was found in 10 episodes (4%); 80% grewC albicansandC glabrata. Risk factors for mixed candidemia were not significantly different from those with monomicrobial candidemia.CONCLUSION:C albicansremains the most commonly isolated species in this setting, consistent with findings from other Canadian centres. However, non-albicans Candidaspecies were overall predominant. Mixed-species candidemia does not appear to be more prevalent in patients with identified risk factors.