Epidemiology of Candida bloodstream infections in a population ofseverely burned patients: a retrospective observational study.

Introduction bloodstream infections (BSIs) caused by Candida spp. are a major complication in burn patients. The aim of this study was to describe the epidemiology of Candida BSIs, in a population of hospitalised burn patients, over an 11-year period. Materials and methods this was an observational, monocentric, retrospective case series. Patients were hospitalised in the Burn Unit of Cesena Hospital, Italy, a 6-bed Intensive Care Unit (ICU) dedicated to burn patients. Data were extracted from the electronic medical records and from the microbiology database. All consecutive patients who experienced a BSI from January 2012 to December 2022 were screened, and those with Candida BSI were included. Results during the study period, 1101 patients were hospitalised and 150 (13.6%) presented at least one BSI. Sixty/150 patients (40%) presented 68 fungal BSIs, due to Candida spp in 67/68 cases (99%; incidence rate of Candida BSI: 60.8/1000 admissions). Candidemia was mainly observed after more than 3 weeks of ICU stay (39/59 patients, 66%; 47/67 episodes, 67%). Candida parapsilosis (CP) was identified in 28/59 patients (47%), followed by Candida albicans (25/59, 42%). Candida parapsilosis BSI was rarely observed during the first years of the study (3 episodes in 2012-2016), while it became more frequent after 2016 (25 episodes in 2017-2022). Thirteen CP strains (46%) were fluconazole-resistant. Fluconazole-resistant CP was mainly observed from 2020 onward. Conclusion candidemia had a high incidence in this population of severely burned patients, particularly in cases of prolonged ICU stay. Candida parapsilosis was the most frequent cause of candidemia. Its incidence and fluconazole resistance have increased sharply in recent years. Running title candida bloodstream infections in burn patients.