Epidemiology, Species Distribution, Antifungal Susceptibility, and Outcome of Candidemia across five sites in Italy and Spain

Candidemia has become an important bloodstream infection that frequently associates a high rate of mortality and morbidity, its growing incidence being related to complex medical and surgical procedures. We conducted a multicentric study in five tertiary care teaching hospitals in Italy and Spain evaluating epidemiology, species distribution, antifungal susceptibility and outcome of candidemia episodes. In the period 2008-2010, 995 episodes of candidemia were identified. The overall incidence was 1.55 cases per 1,000 admissions and remained stable during the three years analysed. Candida albicans was the leading agent (58.4%), followed by Candida parapsilosis complex (19.5%), C. tropicalis (9.3%), and C. glabrata (8.3%). The majority of the candidemia episodes were found in internal medicine department (49.6%), followed by surgery, ICU and hemato-oncology. Out of 955 evaluable patients, 381 (39.9%) died within 30 days from the onset of candidemia. Important differences in 30 days- mortality were noted between institutions: lowest mortality in Barcelona and highest in Udine (33.6% vs 51%, respectively, P 0.0005). Overall, 5.1 % of the 955 isolates tested were resistant or SDD to fluconazole with minor differences between Italy and Spain (5.7% vs 3.5%, P 0.2). Higher MICs for caspofungin were found, especially in C. parapsilosis complex (MIC90 1 μg/mL). Amphotericin B has shown the lowest values of MICs.This report shows that candidemia is a significant source of morbidity in Europe, with a substantial burden of disease and mortality.