Mycological and Clinical Profile of Candidemia in Intensive Care Unit Patients
Abstract
Objective: To analyze the clinical features, risk factors, species distribution, and antifungal susceptibility of Candida bloodstream infections in intensive care unit patients in the context of rising invasive candidiasis and the shift from Candida albicans to non-albicans Candida species with higher antifungal resistance, emphasizing the need for monitoring local epidemiology to guide appropriate antifungal therapy.
Material and Methods: Blood cultures from patients with a strong clinical suspicion of sepsis were included. Blood culture isolates were identified, and antifungal susceptibility testing of Candida isolates was performed. Demographic characteristics, comorbid conditions, clinical parameters, and patient outcomes, including duration of hospital stay and 30-day mortality, were recorded and analyzed.
Results: Out of 4,112 blood cultures, 1,183 (28.8%) were culture positive. The mean time to positivity was 16.4 ± 1.8 hours. Candida spp. were isolated from 27 (2.3%) patients, with NAC species predominating. Diabetes mellitus, corticosteroid use, and indwelling medical devices were significantly associated with Candida BSI. Hospital and ICU stay duration were significantly higher in patients with Candida BSI compared to bacterial BSI. Fluconazole resistance was observed in 18.5% of isolates. The C. parapsilosis complex demonstrated high minimum inhibitory concentrations to echinocandins.
Conclusion: Candida is an important cause of bloodstream infections in ICU patients. The emergence of non-albicans Candida with reduced fluconazole susceptibility and elevated echinocandin MICs in C. parapsilosis complex highlights the need for continuous surveillance and judicious antifungal use.
Keywords
Full Text:
PDF (Early Version)References
Bassetti M, Righi E, Carnelutti A. Bloodstream infections in the intensive care unit. Virulence 2016;7:267-79.
Munro C, Zilberberg MD, Shorr AF. Bloodstream Infection in the Intensive Care Unit: Evolving Epidemiology and Microbiology. Antibiotics 2024;13:123.
Kallel H, Houcke S, Resiere D, Roy M, Claire M, Cyrille M et al., Epidemiology and prognosis of intensive care unit–acquired bloodstream infection. Am J Trop Med Hyg 2020;103:508-14.
Timsit JF, Ruppé E, Barbier F, Tabah A, Bassetti M. Bloodstream infections in critically ill patients: an expert statement. Intensive Care Med 2020;46:266-84.
Xiao G, Liao W, Zhang Y, Luo X, Zhang C, Li G, Yang Y, Xu Y. Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality. BMC Infect Dis 2020;20:599.
Azim A, Ahmed A. Diagnosis and management of invasive fungal diseases in non-neutropenic ICU patients, with focus on candidiasis and aspergillosis: a comprehensive review. Front Cell Infect Microbiol 2024;14:1256158.
Gauer R, Forbes D, Boyer N. Sepsis: Diagnosis and Management. Am Fam Physician 2020;101:409-18.
CLSI. Clinical Laboratory Standards Institute; Wayne, PA: 2007. Principles and procedures for blood culture; approved guideline-1st edition. CLSI document M47-A.
Clinical and Laboratory Standards Institute CLSI. 2017. CLSI standard M27. In Reference method for broth dilution antifungal susceptibility testing of yeasts, 4th ed. Wayne, PA.
Deorukhkar SC, Saini S, Mathew S. Nonalbicans Candida infection: an emerging threat. Interdiscip Perspect Infect Dis 2014;2014:615958.
Deorukhkar SC, Saini S. Echinocandin Susceptibility Profile of Fluconazole Resistant Candida Species Isolated from Blood Stream Infections. Infect Disord Drug Targets 2016; 16:63-8.
Cui Y, Yi C, Zhang C, Yang C, Wang X, Chen W, Peng Y, Dai J. Risk factors for bloodstream infection among patients admitted to an intensive care unit of a tertiary hospital of Shanghai, China. Scientific Reports. 2024; 1:12765.
Deress T, Belay G, Ayenew G, Ferede W, Worku M, Feleke T, et al. Bacterial etiology and antimicrobial resistance in bloodstream infections at the University of Gondar Comprehensive Specialized Hospital: a cross-sectional study. Front Microbiol 2025;16:1518051.
Lambregts MMC, Bernards AT, van der Beek MT, Visser LG, de Boer MG (2019) Time to positivity of blood cultures supports early re-evaluation of empiric broad-spectrum antimicrobial therapy. PLoS One 2019;14:e0208819.
Maffezzoli P, Kestler M, Burillo A, Corcione S, De Rosa FG, Muñoz P, Bouza E. Diagnostic and prognostic value of time to positivity in blood cultures. An opinion paper. Rev Esp Quimioter 2025;38:8-20.
Bhattacharjee P. Epidemiology and antifungal susceptibility of Candida species in a tertiary care hospital, Kolkata, India. Curr Med Mycol 2016;2:20-27.
Kim SH, Yoon YK, Kim MJ, Sohn JW. Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections. Clin Microbiol Infect 2013;19:62-8.
Schroeder M, Weber T, Denker T, Winterland S, Wichmann D, Rohde H et al. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis. Ann Intensive Care 2020;10:142.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.