Background. Candida has emerged as one of the most important pathogens that cause bloodstream infection (BSI).Understanding the current Candida BSI trends, the dominant species causing disease and the mortality associated with this infection are crucial to optimize therapeutic and prophylaxis measures. Objectives. To study the epidemiology and to evaluate the risk factors, prognostic factors, and mortality associated with candidemia and to compare these findings with previously published studies from Saudi Arabia. Design. A retrospective medical record review. Setting. Tertiary hospital in Riyadh. Patients and Methods. The analysis included all cases of Candida blood stream infection who are >18 years old over the period from 2013 to 2018. Continuous variables were compared using the parametric T-test while categorical variables were compared using the Chi-squared test. Main Outcome Measure. Incidence, resistance, and hospital outcomes in Candida blood stream infection. Sample Size. 324 patients. Results. Three hundred and twenty-four episodes of Candida blood stream infections were identified. Median age of patients was 49.7 SD ± 28.1 years, and 53% of patients were males. More than half of the patients had an underlying disease involving the abdomen or laparotomy, 78% had an indwelling intravenous catheter, and 62% had suffered a bacterial infection within 2 weeks prior to candidemia. Candida albicans represents 33% of all isolates with decreasing trend overtime. There was an increase in the number of nonalbicans Candida overtime with Candida tropicalis in the lead (20%). Use of broad spectrum antibiotics (82%), prior ICU admission (60%) and use of central venous catheters (58%) were the most prevalent predisposing factors of candidemia. Azole resistance was variable overtime. Resistance to caspofungin remained very low (1.9%). Fourteen days crude mortality was 37% for ICU patients and 26.7% in non-ICU patients, while hospital crude mortality was 64.4% and 46.7%, respectively. Conclusion. There is an increasing trend of nonalbicans Candida blood stream infection. Fluconazole resistance remained low to C. albicans. Most isolates remain susceptible to caspofungin, voriconazole, and amphotericin B. Candida bloodstream infection is associated with high 14-day hospital mortality.

中文翻译：

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念珠菌血流感染：沙特三级护理医院 10 年来发生模式和抗真菌药物敏感性的变化。

背景。念珠菌已成为导致血流感染 (BSI) 的最重要病原体之一。了解当前念珠菌BSI 趋势，导致疾病的主要物种和与这种感染相关的死亡率对于优化治疗和预防措施至关重要。目标。研究流行病学并评估与念珠菌血症相关的危险因素、预后因素和死亡率，并将这些发现与沙特阿拉伯先前发表的研究进行比较。设计。回顾性病历审查。设置。利雅得的三级医院。患者和方法。分析包括所有案例2013 年至 2018 年期间 > 18 岁的念珠菌血流感染。使用参数T检验比较连续变量，使用卡方检验比较分类变量。主要成果衡量标准。念珠菌血流感染的发生率、耐药性和医院结局。样本量。324 名患者。结果。三百二十四集念珠菌确定了血流感染。患者的中位年龄为 49.7 SD ± 28.1 岁，53% 的患者为男性。超过一半的患者有涉及腹部或剖腹手术的潜在疾病，78% 的患者留置了静脉导管，62% 的患者在念珠菌血症前 2 周内发生过细菌感染。白色念珠菌占所有分离株的 33%，随时间推移呈下降趋势。热带念珠菌加班的非白色念珠菌数量增加领先（20%）。使用广谱抗生素 (82%)、既往 ICU 入院 (60%) 和使用中心静脉导管 (58%) 是念珠菌血症最普遍的诱发因素。唑类抗性随时间变化。对卡泊芬净的耐药性仍然很低（1.9%）。ICU 患者的 14 天粗死亡率为 37%，非 ICU 患者为 26.7%，而医院粗死亡率分别为 64.4% 和 46.7%。结论。非白色念珠菌血流感染呈上升趋势。氟康唑对白色念珠菌的耐药性仍然很低。大多数分离株仍然对卡泊芬净、伏立康唑和两性霉素 B 敏感。念珠菌血流感染与高 14 天住院死亡率相关。