Clinical Features, Strain Distribution, Antifungal Resistance and Prognosis of Patients with Non-albicans Candidemia: A Retrospective Observational Study

Abstract

Purpose

Candida albicans (C. albicans) candidemia has been well reported in previous studies, while research on non-albicans Candida (NAC) bloodstream infections remains poorly explored. Therefore, the present study aimed to investigate the clinical characteristics and outcomes of patients with NAC candidemia.

Patients and Methods

We recruited inpatients with candidemia from January 2013 to June 2020 in a tertiary hospital for this retrospective observational study.

Results

A total of 301 patients with candidemia were recruited in the current study, including 161 (53.5%) patients with NAC candidemia. The main pathogens in NAC candidemia were Candida tropicalis (C. tropicalis) (23.9%), Candida parapsilosis (15.6%) and Candida glabrata (10.3%). Patients with NAC candidemia had more medical admissions (P=0.034), a higher percentage of hematological malignancies (P=0.007), a higher frequency of antifungal exposure (P=0.012), and more indwelling peripherally inserted central catheters (P=0.002) than those with C. albicans candidemia. In a multivariable analysis, prior antifungal exposure was independently related to NAC candidemia (adjusted odds ratio [aOR], 0.312; 95% confidence interval [CI], 0.113–0.859). Additionally, NAC was obviously resistant to azoles, especially C. tropicalis had a high cross-resistance to azoles. However, no significant differences were noted in the mortality rates at 14 days, 28 days and 60 days between these two groups.

Conclusion

NAC is dominant in candidemia, and prior antifungal exposure is an independent risk factor. Of note, although the outcomes of NAC and C. albicans candidemia are similar, drug resistance to specific azoles as well as cross-resistance frequently occurs in patients with NAC candidemia, and this drug resistance deserves attention in clinical practice and further in-depth investigation.

Keywords:

• non-albicans candidemia
• clinical features
• risk factor
• cross-resistance

Abbreviations

1. C. albicans, Candida albicans; NAC, non-albicans Candida; C. parapsilosis, Candida parapsilosis; C. tropicalis, Candida tropicalis; C. glabrata, Candida glabrata; spp., species; BSI, bloodstream infection; IQR, interquartile range; ICU, intensive care unit; CCI, Charlson Comorbidity Index; APACHE, acute physiology and chronic health evaluation; SOFA, sequential organ failure assessment; CRBSI, catheter-related bloodstream infection; GI, gastrointestinal; TPN, total parenteral nutrition; CVC, central venous catheter; PICC, peripherally inserted central catheter; WBC, white blood count; NC, neutrophil count; LC, lymphocyte count; NLR, neutrophil to lymphocyte ratio; TB, total bilirubin; AST, aspartate aminotransferase; ALT, alanine aminotransferase; PCT, procalcitonin; OR, odds ratio; CI, confidence interval; S, susceptible; I, intermediate; R, resistant; RRT, renal replacement therapy.

Data Sharing Statement

All data generated and/or analyzed during the current study are included in this manuscript.

Ethics Approval and Informed Consent

This study received human research ethics approval (NO. 2020-744) from the Ethics Committee of the Second Affiliated Hospital, Zhejiang University School of Medicine. We ensure the confidentiality of patient data and comply with the Helsinki statement. Due to the retrospective nature of the study, the Ethics Committee determined that no patient consent was required.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.