Epidemiology, Risk Factors and Mortality of Fungal Bloodstream Infection: 14 Years of Experience at a Teaching Hospital

Fungal bloodstream infection is a severe condition associated with high mortality rates. Major risk factors of fungal bloodstream infection (BSI) include immunosuppression, abdominal surgery and malignancy. The epidemiology and underlying morbidities vary by geographic region and institute. We analyzed the species distribution, antifungal susceptibility, risk factors and mortality of fungal bloodstream infection at our institute over a 14-year period. Four-hundred and fourteen episodes were detected, and the average annual incidence was 0.23/1000 admissions. The most frequent species was Candida albicans (54%), followed by C. glabrata (16%). Abdominal surgery (48.3%), a solid tumor (31.4%), and immunosuppression (26.3%) were identified as major risk factors. Abdominal surgery was more prevalent in patients suffering from BSI caused by C. albicans or C. glabrata. C. tropicalis and C. albicans were associated with increased mortality in patients with neutropenia and/or immunosuppression. Azole prophylaxis in patients suffering from a hematologic malignancy or who recently had undergone organ transplantation increased the risk of C. krusei BSI. Overall 30-day mortality was 45.7% in any fungal BSI. Mortality of C. tropicalis BSI (59.4%) was the highest. Acquired antifungal resistance was not detected during the study period.