Abstract:

Candida species are the leading cause of invasive fungal infections in hospitalized patients, especially those with a hematological malignancy. The present study aims to determine the prevalence of candidemia, controllable risk factors associated with mortality, and antifungal resistance in patients with hematological malignancy and in light of these information, to obtain information that would guide empirical antifungal treatment, and to contribute to development of infection control strategies as well. We retrospectively reviewed demographical data, laboratory results, antifungal susceptibility, and treatment outcomes of patients with hematological malignancy who were found to have positive blood culture results for Candida between 2009 and 2016 in Hematology Clinic of Uludağ University, Faculty of Medicine Hospital. 45 candidemia episodes were detected in 45 of 2489 patients with hematological malignancies. Majority of these patients had acute leukemia (%75.5). We found the incidence of candidemia in patients with hematological malignancy as %1.8; and this rate was %2.3 in patients with acute leukemia. Species other than C. albicans were dominant in the species distribution of the patients (38/45, 84.4%). C. krusei and C. tropicalis were more common among patients with a hematological malignancy in comparison to other inpatients in general. C. parapsilosis was a common agent for candidemia in both groups. Antifungal resistance was observed in only two C. parapsilosis isolates, against fluconazole. The overall 30-day mortality rate was %55.5. Independent risk factors associated with mortality were hypoalbuminemia, active disease, septic shock, and to receive monotherapy. In conclusion, despite improvements in its treatment, no significant reduction has been achieved in the associated mortality. Local epidemiological studies are still important in the treatment of candidemia. C. parapsilosis is considered to be an indicator of bad catheter management. In our study, C. parapsilosis was detected at a high rate, and it was the only species showing antifungal resistance. This underscores the significance of good catheter management in the fight against candidemia, as well as the importance of epidemiological studies in empirical antifungal treatment strategies.

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