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A longitudinal study of Candida bloodstream infections in a Japanese university hospital: species distribution, drug susceptibility, clinical features, and mortality predictors

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Abstract

We aimed to detect possible changes in Candida species distribution over time and to know the antifungal susceptibility profile of isolates obtained from patients with bloodstream infection (BSI) due to this pathogen. Risk factors associated with 30-day mortality were also assessed. We conducted a retrospective cohort study of patients diagnosed with Candida BSI at a Japanese university hospital from 2013 to 2021. The change in the distribution pattern of the Candida spp. isolated was examined by considering three successive sub-periods of 3 years each. Risk factors for 30-day mortality were determined using Cox regression analysis. In the entire study period, Candida albicans was the most frequent species (46.7%), followed by Candida glabrata (21.5%) and Candida parapsilosis (18.7%). There was no change in Candida species distribution comparing the three sub-periods analyzed. All isolates were susceptible to micafungin, and most were susceptible to fluconazole, except for C. glabrata. No isolates were resistant to amphotericin B or voriconazole. The overall 30-day mortality was 40.2%. Univariate analysis revealed an association between 30-day mortality and central venous catheter (CVC) removal at any time, high Pitt bacteremia score (PBS), and high Charlson comorbidity index (CCI). Multivariate Cox analysis found that high PBS was the only independent predictor of 30-day mortality; subsequent multivariate Cox regression demonstrated that early CVC removal significantly reduced 30-day mortality. Candida species distribution and antifungal susceptibility profile in our hospital remained similar from 2013 to 2021. Early CVC removal may improve candidemia outcomes.

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Our institution does not mandate archiving datasets generated during retrospective analyses, but they will be available on reasonable request.

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Acknowledgements

Editorial support in the form of medical writing, assembling tables, and creating high-resolution images based on authors’ detailed directions, collating author comments, copyediting, fact checking, and referencing was provided by Editage, Cactus Communications.

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Authors and Affiliations

  1. Department of Pharmacy, University of Fukui Hospital, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Hitoshi Tsukamoto, Takashi Higashi, Takaaki Kodawara, Kyohei Watanabe & Nobuyuki Goto

  2. Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan

    Hitoshi Tsukamoto, Yukio Hida & Hiromichi Iwasaki

  3. Medical Research Support Center, University of Fukui Hospital, Fukui, Japan

    Kyohei Watanabe

  4. Clinical Laboratory, University of Fukui Hospital, Fukui, Japan

    Yukio Hida

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  1. Hitoshi Tsukamoto
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Contributions

Conceptualization: Hitoshi Tsukamoto, Takashi Higashi, Takaaki Kodawara, Hiromichi Iwasaki, Nobuyuki Goto.

Data curation: Hitoshi Tsukamoto, Takashi Higashi.

Formal analysis: Hitoshi Tsukamoto, Takashi Higashi, Kyohei Watanabe, Nobuyuki Goto.

Investigation: Hitoshi Tsukamoto, Takashi Higashi, Takaaki Kodawara, Kyohei Watanabe, Yukio Hida.

Project administration: Hiromichi Iwasaki, Nobuyuki Goto.

Supervision: Hiromichi Iwasaki, Nobuyuki Goto.

Validation: Hitoshi Tsukamoto, Takashi Higashi, Takaaki Kodawara, Kyohei Watanabe, Yukio Hida.

Visualization: Hitoshi Tsukamoto.

Writing—original draft: Hitoshi Tsukamoto.

Writing—review and editing: Hitoshi Tsukamoto, Takashi Higashi, Takaaki Kodawara, Kyohei Watanabe, Yukio Hida, Hiromichi Iwasaki, and Nobuyuki Goto.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hitoshi Tsukamoto.

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This study was approved by the institutional review board of the Faculty of Medical Sciences, University of Fukui (approval number: 20120089). The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The requirement for informed consent was waived due to the retrospective nature of the study.

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Tsukamoto, H., Higashi, T., Kodawara, T. et al. A longitudinal study of Candida bloodstream infections in a Japanese university hospital: species distribution, drug susceptibility, clinical features, and mortality predictors. Eur J Clin Microbiol Infect Dis 41, 1315–1325 (2022). https://doi.org/10.1007/s10096-022-04499-0

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