Risk factors, clinical characteristics and mortality of candidemia in non-neutropenic, critically ill patients in a tertiary care hospital



Candida albicans, Bloodstream infections, Non-albicans Candida, Risk assessment, Mortality


Aim: In recent years candida species have emerged as important nosocomial pathogens leading to increased mortality and prolonged hospitalization. In this study, we aimed to determine the distribution of Candida species in the intensive care unit (ICU) and to investigate the risk factors and mortality rates in Candida albicans (CA) and non-albicans Candida infections (NAC).
Methods: This retrospective cohort study was conducted between January 2018 and January 2019. 134 patients hospitalized in the intensive care units with Candida reproduction in their blood cultures were included in the study. Blood cultures were processed, and strain distribution was performed according to routine practice using the automated blood culture system BACTEC 9240 (Becton Dickinson, Maryland, USA).
Results: Candida growth was detected in the blood culture of 134 patients, among which 54.5% consisted of CA and 45.5% of NAC. NAC was most commonly followed by C. parapsilosis (17.2%), and C. glabrata (13.4%). Mortality rate of patients aged ≥60 years was significantly higher in all three candida species (P=0.003). NAC was seen at an insignificantly higher rate in patients with solid-organ malignancy (P=0.09). Although mortality was higher in CA than NAC strain (53.6% and 43.4%, respectively), this was not statistically significant (P=0.83).
Conclusion: Although CA is still the most common strain in ICU patients, the incidence of NAC is increasing. Candidemia has high mortality rates in ICU patients. Especially elderly patients with underlying diseases should be followed carefully.


Download data is not yet available.


Guinea J. Global trends in the distribution of candida species causing candidemia. Clin Microbiol Infect. 2014 Jun;20 Suppl 6:5-10.

Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial blood stream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999 Aug;29(2):239-44.

Marchetti O, Bille J, Fluckiger U, Eggimann P, Ruef C, Garbino J, et al. Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000. Clin Infect Dis. 2004 Feb 1;38(3):311-20.

Bassetti M, Merelli M, Ansaldi F, de Florentiis D, Sartor A, Scarparo C, et al. Clinical and therapeutic aspects of candidemia: a five year single centre study. PLoS One. 2015 May 26;10(5):e0127534.

Ben-Ami R. Treatment of Invasive Candidiasis: A Narrative Review. J Fungi (Basel). 2018 Aug 16;4(3).

Gong X, Luan T, Wu X, Li G, Qiu H, Kang Y, et al. Invasive candidiasis in intensive care units in China: Risk factors and prognoses of Candida albicans and non-albicans Candida infections. Am J Infect Control. 2016 May 1;44(5):e59-63.

Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review.Int J Infect Dis. 2010 Nov;14(11):e954-66.

Méan M, Marchetti O, Calandra T. Bench-to-bedside review: Candida infections in the intensive care unit. Crit Care. 2008;12(1):204.

Montagna MT, Lovero G, Borghi E, Amato G, Andreoni S, Campion L, et al. Candidemia in intensive care unit: a nation wide prospective observational survey (GISIA-3 study) and review of the European literature from 2000 through 2013. Eur Rev Med Pharmacol Sci. 2014;18(5):661-74.

Bassetti M, Mikulska M, Viscoli C. Bench-to-bedside review: therapeutic management of invasive candidiasis in the intensive care unit. Crit Care. 2010;14(6):244.

Pfaller MA, Jones RN, Doern GV, Sader HS, Hollis RJ, Messer SA. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and antifungal susceptibilities of isolates collected in 1997 in the United States, Canada, and South America for the SENTRY Program. The SENTRY Participant. J Clin Microbiol. 1998 Jul;36(7):1886-9.

De Luca C, Guglielminetti M, Ferrario A, Calabr M, Casari E. Candidemia: species involved, virulence factors and antimycotic susceptibility. New Microbiol. 2012;35(4):459–68.

Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014 Feb 13;10:95-105.

Arabacı Ç, Kutlu O. Evaluation of microorganisms isolated from blood cultures and their susceptibility profiles to antibiotics in five years period. J Surg Med. 2019;3(10):729-33.

Dizbay M, Fidan I, Kalkanci A, Sari N, Yalcin B, Kustimur S, et al. High incidence of Candida parapsilosis Candidaemia in non-neutropenic critically ill patients: epidemiology and antifungal susceptibility. Scand J Infect Dis. 2010;42(2):114-20.

Horasan ES, Ersöz G, Göksu M, Otag F, Kurt AO, Karaçorlu S, et al. Increase in Candida parapsilosis fungemia in critical care units: a 6-years study. Mycopathologia. 2010;170(4):263-8.

Serefhanoglu K, Timurkaynak F, Can F, Cagir U, Arslan H, Ozdemir FN. Risk factors for candidemia with non-albicans Candida spp. in intensive care unit patients with end-stage renal disease on chronic hemodialysis. J Formos Med Assoc. 2012 Jun;111(6):325-32.

Malani A, Hmoud J, Chiu L, Carver PL, Bielaczyc A, Kauffman CA. Candida glabrata fungemia: experience in a tertiary care center. Clin Infect Dis. 2005 Oct 1;41(7):975-81.

Tortorano AM, Kibbler C, Peman J, Bernhardt H, Klingspor L, Grillot R. Candidemia in Europe: epidemiology and resistance. Int J Antimicrob Agents. 2006 May;27(5):359-66.

Weinberger M, Leibovici L, Perez S, Samra Z, Ostfeld I, Levi I, et al. Characteristics of candidemia with Candida-albicans compared with non-albicans Candida species and predictors of mortality. J Hosp Infect. 2005 Oct;61(2):146-54.

Das I, Nightingale P, Patel M, Jumaa P. Epidemiology, clinical characteristics, and outcome of candidemia: experience in a tertiary referral center in the UK. Int J Infect Dis. 2011 Nov;15(11):e759-63.

Chi HW, Yang YS, Shang ST, Chen KH, Yeh KM, Chang FY, et al. Candida albicans versus non-albicans bloodstream infections: the comparison of risk factors and outcome. J Microbiol Immunol Infect. 2011 Oct;44(5):369-75.

Yılmaz Karadağ F, Ergen P, Aydın Ö, Doğru A, Tanıdır B, Vahaboğlu MH. Evaluation of epidemiological characteristics and risk factors affecting mortality in patients with candidemia. Turk J Med Sci. 2016 Dec 20;46(6):1724-1728.

Li D, Xia R, Zhang Q, Bai C, Li Z, Zhang P. Evaluation of candidemia in epidemiology and risk factors among cancer patients in a cancer center of China: an 8-year case-control study. BMC Infect Dis. 2017 Aug 3;17(1):536.

Kawano Y, Togawa A, Nakamura Y, Mizunuma M, Yamasaki R, Hoshino K,et al. Prognostic factors for candidaemia in intensive care unit patients: a retrospective analysis. Singapore Med J. 2017 Apr;58(4):196-200.

Marriott DJ, Playford EG, Chen S, Slavin M, Nguyen Q, Ellis D, et al. Australian Candidaemia Study. Determinants of mortality in non-neutropenic ICU patients with candidaemia. Crit Care. 2009;13(4):R115.






Research Article

How to Cite

Tümtürk A. Risk factors, clinical characteristics and mortality of candidemia in non-neutropenic, critically ill patients in a tertiary care hospital. J Surg Med [Internet]. 2020 Feb. 1 [cited 2024 May 20];4(2):157-60. Available from: https://jsurgmed.com/article/view/686677