Candidaemia is the commonest fungal bloodstream infection in hospitalised patients. Diabetes is one of the risk factors for mortality from candidaemia.
Methods:
We compared the epidemiology, clinical characteristics and management of candidaemia in patients with and without diabetes.
Results:
Over a 10-year period, 200 episodes of Candida bloodstream infection were documented. Patients with diabetes were younger (58.7 vs 65.5 years), less likely to be suffering from cancer (21.8% vs 36%), and had significantly lower 30-day and 90-day crude mortality (17.2% vs 35.6% and 28.4% vs 48.6%, respectively). Candida glabrata was more common in patients with diabetes (39.3% vs 29.7%). Based on European Confederation of Medical Mycology (ECMM) quality indicators, the management of patients with and without diabetes was similar.
Discussion:
Our study highlights the importance of epidemiological data in relation to candidaemia in patients with diabetes and the growing threat of invasive C. glabrata infection in this subset of patients.
TrouveCBlotSHayetteMPet al. Epidemiology and reporting of candidaemia in Belgium: a multi-centre study. Eur J Clin Microbiol Infect Dis2017; 36: 649–55.
3.
MartiniCTorelliRde GrootTet al. Prevalence and clonal distribution of azole-resistant Candida parapsilosis isolates causing bloodstream infections in a large Italian hospital. Front Cell Infect Microbiol2020; 10: 232.
4.
JamiuATAlbertynJSebolaiOMet al. Update on Candida krusei, a potential multidrug-resistant pathogen. Med Mycol2021; 59: 14–30.
5.
PaphitouNIOstrosky-ZeichnerLRexJH.Rules for identifying patients at increased risk for candidal infections in the surgical intensive care unit: approach to developing practical criteria for systematic use in antifungal prophylaxis trials. Med Mycol2005; 43: 235–43.
6.
MorABerencsiKNielsenJSet al. Rates of community-based antibiotic prescriptions and hospital-treated infections in individuals with and without type 2 diabetes: a Danish nationwide cohort study, 2004–2012. Clin Infect Dis2016; 63: 501–11.
7.
HostetterMK.Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans. Diabetes1990; 39: 271–5.
8.
BaderMSHinthornDLaiSMet al. Hyperglycaemia and mortality of diabetic patients with candidaemia. Diabet Med2005; 22: 1252–7.
9.
RajendranRSherryLDeshpandeAet al. A prospective surveillance study of candidaemia: epidemiology, risk factors, antifungal treatment and outcome in hospitalized patients. Front Microbiol2016; 7: 915.
10.
PappasPGKauffmanCAAndesDRet al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis2016; 62: e1–50.
11.
SmythJMullenCCJackLet al. Diabetes, malignancy and age as predictors of Candida glabrata bloodstream infection: a re-evaluation of the risk factors. J Mycol Med2018; 28: 547–50.
12.
MellinghoffSCHoeniglMKoehlerPet al. EQUAL Candida score: an ECMM score derived from current guidelines to measure QUAlity of clinical candidaemia management. Mycoses2018; 61: 326–30.
13.
KingHAubertREHermanWH.Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care1998; 21: 1414–31.
14.
LaoMLiCLiJet al. Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: clinical features and associated factors. J Diabetes Investig2020; 11: 731–44.
15.
RodriguesCFRodriguesMEHenriquesM.Candida sp. infections in patients with diabetes mellitus. J Clin Med2019; 8: 76.
16.
TodaMWilliamsSRBerkowELet al. Population-based active surveillance for culture-confirmed candidemia - four sites, United States, 2012–2016. MMWR Surveill Summ2019; 68: 1–15.
17.
PappasPGRexJHLeeJet al. A prospective observational study of candidemia: epidemiology, therapy, and influences on mortality in hospitalized adult and pediatric patients. Clin Infect Dis2003; 37: 634–43.
18.
AgnelliCValerioMBouzaEet al. Prognostic factors of Candida spp. bloodstream infection in adults: a 9-year retrospective cohort study across tertiary hospitals in Brazil and Spain. The Lancet Regional Health - Americas2022; 6: 100117.
19.
KhatibRJohnsonLBFakihMGet al. Current trends in candidemia and species distribution among adults: Candida glabrata surpasses C. albicans in diabetic patients and abdominal sources. Mycoses2016; 59: 781–6.
20.
RayDGoswamiRBanerjeeUet al. Prevalence of Candida glabrata and its response to boric acid vaginal suppositories in comparison with oral fluconazole in patients with diabetes and vulvovaginal candidiasis. Diabetes Care2007; 30: 312–7.
21.
GuineaJ.Global trends in the distribution of Candida species causing candidemia. Clin Microbiol Infect2014; 20: 5–10.
22.
MaccallumDM.Hosting infection: experimental models to assay Candida virulence. Int J Microbiol2012; 2012: 363764.
23.
MoranCGrussemeyerCASpaldingJRet al. Comparison of costs, length of stay, and mortality associated with Candida glabrata and Candida albicans bloodstream infections. Am J Infect Control2010; 38: 78–80.
24.
BreazzanoMPBondJB3rdBearellySet al. American academy of ophthalmology recommendations on screening for endogenous Candida endophthalmitis. Ophthalmology2022; 129: 73–6.
25.
CornelyOABassettiMCalandraTet al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect2012; 18: 19–37.
