Increasing morbidity and mortality of candidemia over two decades in a swiss university hospital

Background. Candidemia is the most frequent nosocomial fungal infection. Its epidemiology is evolving with raising concern about the emergence of intrinsically resistant non-albicans Candida species and acquired antifungal resistance. Most candidemia surveys are based on microbiological databases. Epidemiological studies including demographic and clinical data are needed to assess the impact of candidemia on morbidity and mortality. Objectives. To assess the clinical and microbiological trends of candidemia in a Swiss university hospital over two decades. Patients / Methods. This single-center retrospective study compared the incidence of candidemia, Candida species distribution, antifungal resistance profiles, clinical characteristics, and outcomes between two periods separated by one decade. Results. 170 candidemic episodes were included (68 from period 1, 2004-2006, and 102 from period 2, 2014-2017). Incidence of candidemia (0.9 to 1 episode/10000 patient-days), Candida species distribution (C. albicans 57% to 55%) and antifungal resistance rates (<3%) remained unchanged over time. However, a significant demographic evolution was observed in period 2 with candidemia occurring more frequently in older patients and in the intensive care units (ICU). The impact of candidemia on morbidity and mortality also evolved with higher proportions of patients with septic shock (23% vs 7%, p=0.01), subsequent need for ICU admission (42% vs 12%, p<0.01) and in-hospital mortality (34% vs 18%, p=0.03) in period 2 compared to period 1. Conclusions. Despite stable incidence, species distribution, and antifungal resistance of candidemia over two decades, the shift towards older and critically ill populations resulted in increased morbidity and mortality