Multifocal Candida infections in cancer patients face dual challenges of surgical risk and drug resistance

Abstract

Multifocal Candida infections represent a serious threat for cancer patients, often leading to increased mortality. This study investigates the risk factors and outcomes for multifocal Candida infections compared to single-site infections and evaluates species distribution and antifungal susceptibility patterns. Fifty-seven Candida isolates were obtained from 23 cancer patients with multifocal infections. Another 57 isolates were collected from 57 matched patients with single-site infections. Germ tube test and CHROMAgar medium were used for species identification. Antifungal susceptibility of amphotericin B, caspofungin, fluconazole, and voriconazole was determined following the Clinical and Laboratory Standard Institute (CLSI), M60-Ed2. Of the 80 cancer patients, the majority of cases involved solid tumors (85.0 %), with gastrointestinal cancer being the most common in both multifocal and single-focal groups (p = 0.207). Significantly more patients with multifocal infections were admitted to the ICU compared to those with single-site infections (60.9 % versus 34.0 %, p = 0.029). Surgical procedures independently increased the risk for multifocal infections (OR: 10.506, p = 0.047). Multifocal infections had a significantly higher mortality rate than single-site infections (69.6 % versus 42.1 %, OR: 3.143, p = 0.026). Non-albicans Candida (NAC) species constituted 57.9 % (n = 66) of the 114 isolates, with Candida glabrata being the most prevalent (n = 49, 43.0 %). All tested antifungals revealed high resistance rates, particularly amphotericin B (79.8 %) and fluconazole (53.5 %). NAC species demonstrated significantly higher resistance rates than Candida albicans. Multifocal Candida infections in cancer patients showed higher mortality, with surgical procedures and ICU admission as key risk factors. The increasingly prevalent resistant NAC species, particularly C. glabrata, need accurate identification, antifungal stewardship, and new therapeutic strategies.