Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Dec 25, 2024; 13(4): 98839
Published online Dec 25, 2024. doi: 10.5501/wjv.v13.i4.98839
Candidemia chronicles: Retrospective analysis of candidemia epidemiology, species distribution, and antifungal susceptibility patterns in Bahrain
Nermin Kamal Saeed, Safiya Almusawi, Mohammed Al-Beltagi
Nermin Kamal Saeed, Safiya Almusawi, Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 12, Bahrain
Nermin Kamal Saeed, Safiya Almusawi, Department of Medical Microbiology, Royal College of Surgeons in Ireland–Bahrain, Busaiteen 15503, Bahrain
Mohammed Al-Beltagi, Department of Pediatric, Faculty of Medicine, Tanta University, Tanta ‎ 31511‎, Egypt
Mohammed Al-Beltagi, Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
Author contributions: Saeed NK, Almusawi S, and Al-Biltagi M contributed substantially to this retrospective study's design and implementation; Saeed NK and Almusawi S were primarily responsible for data collection, ensuring accuracy and completeness; Saeed NK took the lead in drafting the initial manuscript; Almusawi S contributed significantly to the writing and organization of the content; Al-Biltagi M provided critical revisions, offering expert insights and guidance on the manuscript's scientific and clinical content; all authors reviewed and approved the final version of the manuscript.
Institutional review board statement: The Secondary Care Research Committee of Salmaniya Medical Complex, Ministry of Health, United Kingdom of Bahrain, has approved the study. However, ethical consideration was unnecessary as it was a non-interventional, retrospective study that did not expose patient data.
Informed consent statement: No informed consent was needed as the study was a retrospective analysis of the laboratory data without personnel information.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this study. The research was conducted independently, without any financial or personal relationships that could have influenced the work reported in this manuscript.
Data sharing statement: The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request. All data have been anonymized to ensure confidentiality and are shared in accordance with relevant ethical guidelines and institutional policies.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, MBChB, MD, PhD, Academic Editor, Chairman, Full Professor, Research Scientist, Department of Pediatric, Faculty of Medicine, Tanta University, Al-Bahr Street, The Medical Complex, Tanta ‎ 31511‎, Egypt. mbelrem@hotmail.com
Received: July 7, 2024
Revised: August 16, 2024
Accepted: August 26, 2024
Published online: December 25, 2024
Processing time: 102 Days and 19.6 Hours
Abstract
BACKGROUND

Invasive fungal infections, particularly candidemia, pose significant clinical challenges globally. Understanding local epidemiology, species distribution, and antifungal susceptibility patterns is crucial for effective management despite regional variations.

AIM

To investigate the epidemiology, species distribution, antifungal susceptibility patterns, and associated risk factors of candidemia among patients in Bahrain from 2021 to 2023.

METHODS

This retrospective study analyzed demographic data, Candida species distribution, antifungal susceptibility profiles, and risk factors among candidemia patients treated at a tertiary care hospital in Bahrain over three years. Data was collected from medical records and analyzed using descriptive statistics.

RESULTS

A total of 430 candidemia cases were identified. The mean age of patients was 65.7 years, with a mortality rate of 85.5%. Candida albicans (C. albicans) was the most common species, followed by Candida parapsilosis, Candida tropicalis (C. tropicalis), and emerging multidrug-resistant Candida auris (C. auris). Antifungal susceptibility varied across species, with declining susceptibility to azoles observed, particularly among C. albicans and C. tropicalis. Major risk factors included central venous catheters, broad-spectrum antibiotics, and surgical procedures.

CONCLUSION

This study highlights the substantial burden of candidemia among older adults in Bahrain, characterized by diverse Candida species. It also concerns levels of antifungal resistance, notably in C. auris. The findings underscore the importance of local epidemiological surveillance and tailored treatment strategies to improve outcomes and mitigate the spread of multidrug-resistant Candida species. Future research should focus on molecular resistance mechanisms and optimizing therapeutic approaches to address this growing public health concern.

Keywords: Candidemia; Fungal infections; Antifungal resistance; Epidemiology; Risk factors; Antifungal susceptibility; Bahrain

Core Tip: This study underscores the significant burden of candidemia in Bahrain, highlighting demographic trends, species distribution, antifungal susceptibility patterns, and critical risk factors over three years. The emergence of multidrug-resistant Candida species, particularly Candida auris, poses challenges to clinical management. High mortality rates underscore the critical need for early detection, prompt initiation of appropriate antifungal therapy guided by susceptibility testing, and rigorous infection control measures. Healthcare providers should prioritize antimicrobial stewardship, minimize invasive procedures when possible, and enhance surveillance efforts to mitigate the rising threat of antifungal resistance and improve patient outcomes in candidemia management.