Epidemiology of candidemia at a tertiary Canadian hospital, 2004–2013

Introduction: Candidemia carries significant morbidity and mortality for hospitalized patients. Local epidemiology is needed to develop strategies to reduce infections. This article describes the epidemiology of candidemia at a tertiary-care hospital in Edmonton, Canada. Methods: Between 2004 and 2013, 250 episodes of candidemia were identified using an infection control database. Binary logistic regression analysis was used to identify risk factors for non-albicans isolates and for mortality. Results: The candidemia rate increased significantly, from 0.387/10,000 patient days (PD) in 2004 to 1.45/10,000 PD in 2013 (p=0.0061). The 30-day and overall in-hospital mortality rates were 38% and 47%, respectively. Candida albicans and C. glabrata represented 80% of isolates. Overall, 48% of episodes were attributable to central venous catheter (CVC) infections. The ratio of C. albicans to non-albicans isolates and the rate of CVC infections did not change significantly over the study period (p=0.98 and 0.14, respectively). Preceding azole therapy within 30 days of candidemia conferred an increased risk of a non-albicans isolate (odds ratio [OR] 2.59, 95% CI 1.24 to 5.43). Mortality was increased with immunosuppression (OR 3.30, 95% CI 1.74 to 6.24) and age, with an OR of 2.78 (95% CI 1.21 to 6.38) for the 61- to 68-year-old age group and an OR of 4.30 (95% CI 1.84 to 10.04) for the >69-year-old age group. Mortality was similar among C. albicans and non-albicans infections (OR 0.85, 95% CI 0.49 to 1.45). Conclusion: Candidemia at the authors' institution increased during the study period without a significant change in the ratio of C. albicans to other Candida spp. The risk of non-albicans candidemia was affected by previous azole therapy, and the risk of mortality was higher with increased age and immunosuppression. The etiology of the increased candidemia rate is likely complex, and strategies to address this, as well as the high mortality rate seen with candidemia, are needed.