Candidemia at selected Canadian sites: Results from the fungal disease registry, 1992-1994

Background: Candida species are important bloodstream pathogens that are be ing isolated with increasing frequency. Despite the availability of effecti ve antifungal therapy, the mortality rate associated with Candida infection remains high. With the objective of describing the epidemiology of candide mia, the Canadian Infectious Disease Society conducted a study of candidemi a in Canada. Methods: Fourteen medical centres across Canada identified all patients wit h candidemia from March 1992 to February 1994 through blood culture surveil lance. for Candida spp. Patient-related data for invasive fungal infection were compiled retrospectively by chart review using a standardized data-rec ording form developed for the Fungal Disease Registry of the Canadian Infec tious Disease Society. Cases of candidemia were studied in relation to unde rlying medical conditions, predisposing factors, concurrent infection, anti microbial agents, antifungal treatment and deaths. Results: In total, 415 cases of candidemia were identified, 48 (11.6%) in c hildren and 367 (88.4%) in adults. The causative pathogens were C. albicans in 286 cases (68.9%), C. parapsilosis in 43 (10.4%), C. glabrata in 34 (8. 2%), C. tropicalis in 27 (6.5%) and other Candida species in 18 (4.3%); pol ymicrobial candidemia occurred in 7 cases (1.7%). The overall mortality rat e was 46%, and the rate of deaths clinically related to candidemia was 19%. However, only 13 (27%) of the children died. A univariate analysis indicat ed that significant risk factors for death were age greater than 60 years, therapy for concomitant bacterial infection, stay in an intensive care unit , concurrent malignant disease, cytotoxic chemotherapy and granulocytopenia , although only age and stay in an intensive care unit emerged as significa nt risk factors in the multivariate analysis. After adjustment for other pr edictors of death, only infection with C. parapsilosis was associated with a lower mortality rate than infection with C. albicans. Treatment was given in 352 (84.8%) of cases. Amphotericin B was the preferred agent in 244 cas es(69.3% of those treated); fluconazole was used in 101 cases (28.7%) and k etoconazole in 5 cases (1.4%). Interpretation: Candidemia in Canada is caused predominantly by C. albicans . The mortality rate associated with candidemia is high, but it varies with the species of Candida and is lower in children than in adults. Age greate r than 60 years and stay in an intensive care unit were the most significan t risk factors for overall mortality.