A five-year multicentre evaluation of candidaemia in UK adults: Epidemiology, risk factors and outcomes.

OBJECTIVES

To evaluate the epidemiology and outcomes of candidaemia in hospitalised adults

METHODS

A five-year (January 2015-December 2019) retrospective multi-site evaluation of candidaemia episodes in hospitalised adults at three London hospitals to assess Candida species, infection source, antifungal resistance, management and mortality.

RESULTS

342 episodes of candidaemia in 333 patients were recorded. Common predisposing risk factors for candidaemia included vascular catheters, abdominal surgery, malignancy and diabetes. Candida albicans (36%), Candida glabrata/ Nakaseomyces glabratus (35%), and Candida parapsilosis (13%), were the most common causative species, with N. glabratus and C. parapsilosis associated with abdominal and line-related sources respectively. Fluconazole resistance was observed in 14% of isolates, while echinocandin resistance was rare (3%). Candida endocarditis and ocular candidiasis occurred in 5.2% and 2.6% of those assessed respectively; both were associated with persistent candidaemia (≥2 successive days). All-cause 30-day mortality was 32%. Age>60 years, liver disease, malignancy, non-removable source of candidaemia and lack of initial echinocandin therapy were independent baseline predictors of mortality.

CONCLUSIONS

Candidaemia is a significant healthcare-associated infection with high mortality, particularly in ICU patients with difficult-to-clear foci. The rise of N. glabratus is concerning given its propensity for antifungal resistance. Future clinical and research priorities include better diagnostic tools and refinement of antifungal treatment strategies.