A five-year multicentre evaluation of candidaemia in UK adults: Epidemiology, risk factors and outcomes

OBJECTIVES: To evaluate the epidemiology and outcomes of candidaemia in hospitalised adults METHODS: A five-year (January 2015-December 2019) retrospective multi-site evaluation of candidaemia episodes in hospitalised adults at three London hospitals to assess Candida species, infection source, antifungal resistance, management and mortality. RESULTS: 342 episodes of candidaemia in 333 patients were recorded. Common predisposing risk factors for candidaemia included vascular catheters, abdominal surgery, malignancy and diabetes. Candida albicans (36%), Candida glabrata/ Nakaseomyces glabratus (35%), and Candida parapsilosis (13%), were the most common causative species, with N. glabratus and C. parapsilosis associated with abdominal and line-related sources respectively. Fluconazole resistance was observed in 14% of isolates, while echinocandin resistance was rare (3%). Candida endocarditis and ocular candidiasis occurred in 5.2% and 2.6% of those assessed respectively; both were associated with persistent candidaemia (≥2 successive days). All-cause 30-day mortality was 32%. Age>60 years, liver disease, malignancy, non-removable source of candidaemia and lack of initial echinocandin therapy were independent baseline predictors of mortality. CONCLUSIONS: Candidaemia is a significant healthcare-associated infection with high mortality, particularly in ICU patients with difficult-to-clear foci. The rise of N. glabratus is concerning given its propensity for antifungal resistance. Future clinical and research priorities include better diagnostic tools and refinement of antifungal treatment strategies.