Title : Analysis of candida spp infections in adult intensive care units in santander, Colombia
Abstract:
Invasive mycoses are linked to higher mortality and morbidity (1). Most of these infections are hospital acquired, frequent in intensive care units and account approximately for 15% of healthcare related infections (1, 2). The aim of this paper is to analyse available data on healthcare related Candida Spp. infections in adult patients taken care at Santander’s intensive care units. Data is available through mandatory reports to the Ministry of Health (3).
Nine hospitals in Santander reported 768 hospital acquired infections in adults between 2016 and 2022. 9,8% of those infections were caused by Candida Spp. and most of the cases occurred in male patients, with an average age of 59 years. The number of infections caused by Candida Spp per year is detailed in Table 1. Between 2016 and 2019 the number of cases remained relatively stable and in 2020 and 2021 the number of cases arose significantly reaching the highest number of 24 confirmed cases in 2021. Most of the cases are caused by Candida albicans and Candida tropicalis, 46% and 32% respectively. The most common infection sites were the urinary tract and the bloodstream. The average mortality rate was 22,6% between 2016 and 2022, with information per year detailed in Table 2. The years 2017 and 2019 had lower total confirmed cases and had higher mortality rates, and 2020 and 2021 had lower mortality rates with higher absolute number of confirmed deaths related with Candida spp infections. The average age of patients who died was higher than those who survived (57 years and 62 years, respectively) but there was no statistically significant association between average age and mortality (p-value=0,33).
The results of this case series are like those reported on previous studies (4, 5). Most cases are diagnosed in male patients. The main etiological agents are Candida albicans and Candida tropicalis, and non-albicans species are becoming relevant pathogens that cause many invasive mycoses in this series as well as other reported ones (4). The Candida spp. isolates are most frequently encountered in blood, urine, and sputum samples (4). In this case series Candida spp. isolates were isolated mainly in urine and blood culture with little representation of other sample types. Age has been identified as a relevant risk factor, with most cases occurring in patients older than 60 years old. This case series has an overall average age of 59 years, with lower average age in those who survived but, unlike other series, age was not statistically related with mortality. Mortality rates are not close to those previously reported (6, 7). The average mortality rate reported in this case series was 22,6%, with previously reported mortality rates as higher as 40-50% (6, 7). Although some years show a similar mortality rate, more recent results from 2020 and 2021 show a lower mortality rate. Finally, there is a change in the number of confirmed Candida spp. infections between 2020 and 2021 attributed to an increase in the number of ICU patients due to the COVID-19 pandemic.
Table 1: Number of Candida Spp. infections per year in adult intensive care units
|
Year |
Number of cases per year |
|
2016 |
10 |
|
2017 |
6 |
|
2018 |
10 |
|
2019 |
6 |
|
2020 |
13 |
|
2021 |
24 |
|
2022 |
6 |
Table 2: Mortality rate of Candida Spp. infections per year in adult intensive care units
|
Year |
Number of cases |
Number of deceased cases |
Mortality rate |
|
2016 |
10 |
1 |
10% |
|
2017 |
6 |
3 |
50% |
|
2018 |
10 |
2 |
20% |
|
2019 |
6 |
3 |
50% |
|
2020 |
13 |
2 |
15,4% |
|
2021 |
24 |
7 |
29,2% |
|
2022 |
6 |
0 |
0 |
