Epidemiology and Risk Factors of Candidemia Among Hospitalized Patients in a Turkish Tertiary Care Hospital

Background: Candidemia, which constitutes 50 -70% of invasive Candida infections, is an important clinical condition with high mortality and difficulty in diagnosis and treatment. Our objective was to determine the epidemiology, risk factors of candidemia, the distribution, and antifungal susceptibilities of Candida spp. responsible for candidemia among hospitalized patients in Gazi University Medical Faculty Hospital. Methods: This was a laboratory-based, prospective observational study conducted between 2009 and 2010. The definition of nosocomial candidemia was based on CDC criteria. All relevant demographic and clinical data were collected from patient files. Candida spp. were identified by API ID32C system. Antifungal susceptibility testing was performed using broth microdilution method according to CLSI. Results: Seventy-one candidemia episodes were identified with the incidence of 0.94 cases/1,000 hospital admissions. C. albicans was isolated in 47.9% of the admissions and in 52.1% of non-albicans Candida admissions. Among the latter, C. parapsilosis and C. tropicalis were the mostfrequent species. The most common risk factors were use of antibiotics (94.4%), hospitalization in the last 1 month (93%), history of hospitalization in ICU (74.6%), and CVC use (70.4%). Abdominal surgery, urethral catheter insertion, and use of piperacillin/tazobactam was found to increase the risk of C. albicans. A history of hospitalization within the last 3 months increased the risk of developing candidemia with non-albicans Candida spp. In total, fluconazole resistance was 20% (24.2% for C. albicans and 16.2% for non-albicans Candida strains) and voriconazole resistance was 5.7% (12.1% for C. albicans and 0% for non-albicans Candida). Conclusions: This study provided a relevant source of information for the prediction of high-risk patients and the implementation of prevention strategies for nosocomial candidemia.