Patients with the Diagnosis of Malignancy Followed Up with Candidemia in a Tertiary University Hospital: Analysis of Species and Resistance

Abstract

Introduction: The incidence of Candidemia, which is a significant cause of morbidity and mortality, is increasing. Patients with a diagnosis of malignancy, who use immunosuppressants, and who require follow-up in the intensive care unit are at high risk for Candidemia. The incidence and resistance patterns of Candida species may vary depending on population, geographical location, and previous antifungal exposure. It was aimed to identify Candida spp. isolated from blood culture samples of patients diagnosed with malignancy for the species level, and to determine their antifungal drug susceptibility, in this study. Materials and Methods: In this study, the results of the samples with growth in blood cultures between January 2016 and July-2022 were examined retrospectively. The patients with a diagnosis of Candida spp. fungal growth in at least one blood culture set during hospitalization and the patients with a diagnosis of malignancy defined as candidemia and treated with antifungal were included in the study. Results: Candida albicans growth was detected in 43.5% (10) of the blood cultures included in the study. Non-albicans species were isolated in a total of 13 blood cultures (56.5%): 30.4% (7) C. parapsilosis; 17.4% (4) C. glabrata; 4.3% (1) C. tropicalis; 4.3% (1) C. krusei. Very low resistance rates were determined against many antifungals such as Amphotericin B (0%), Micafungin (0%), Fluconazole (10%), Posaconazole (0%), Voriconazole (0%), and Anidulafungin (25%) for C. albicans isolates in our study. On the other hand, higher levels of resistance were observed for almost all antifungals for non-albicans species, the incidence of which has increased in recent years. Discussion and Suggestions: The epidemiology of Candida infections has been changing in recent years. Although C. albicans is still the main reason for invasive Candidiasis in many clinical environments, a significant number of patients are now infected with non-albicans Candida species. Candida species may show differential susceptibility to commonly used antifungal agents. The susceptibility of Candida species to commonly used antifungal agents varies. As in our study, we believe that following the epidemiological data and antifungal susceptibility patterns of medical centers will allow effective empirical treatment and improve Candidemia prognosis.