Candidemia chronicles: Retrospective analysis of candidemia epidemiology, species distribution, and antifungal susceptibility patterns in Bahrain

Table 1 Demographic data of patients affected with fungemia over the three years of the study, n (%)

		2021	2022	2023	Total
Total number		161	143	126	430
Age (years)	mean ± SD	66.9 ± 26.7	68.6 ± 18.8	62.87 ± 19	65.7 ± 18.8
	Median	70	72	68	70
Sex	Male	84 (52.2)	79	62	225
	Female	77 (47.8)	64	64	205
	Male:female ratio	1.1:1	1.23:1	0.96:1	1.1:1
Nationality	Bahraini	131 (81.4)	123 (86)	111 (88)	365 (85)
	Non-Bahraini	30 (18.6 )	20 (14)	15 (12)	65 (15)
Prognosis	Live	23 (14.3)	26 (18.2)	13 (10)	62 (14.5)
	Deceased	138 (85.7)	117 (81.8)	113 (90)	368 (85.5)
Candida species	Candida albicans	48 (30)	22 (15.4)	33 (26.2)	103 (24)
	Candida tropicalis	30 (18.6)	29 (20.3)	23 (18.2)	82 (19)
	Candida parapsilosis	29 (18)	36 (25.2)	29 (23)	94 (22)
	Candida glabrata	19 (11.8)	7 (5)	10 (8)	36 (8)
	Candida auris	13 (8)	38 (26.5)	27 (23)	78 (18)
	Candida species	6 (3,7)	1 (0.7)	0	7 (1.6)
	Candida dubliniensis	4 (2.5)	1 (0.7)	1 (0.7)	6 (1.3)
	Candida lusitaniae	3 (1.9)	1 (0.7)	2 (1.4)	6 (1.3)
	Candida orthopsilosis	3 (1.9)	3 (2)	1 (0.7)	7 (1.6)
	Candida guilliermondii	2 (1.25)	0	0	2 (0.4)
	Candida metapsilosis	2 (1.25)	3 (2)	1 (0.7)	6 (1.3)
	Candida rugosa	2 (1.25)	0
	Candida krusei	0	2 (1.4)	1 (0.7)	3 (0.7)
	Candida Cyberlindnera fabianii	1 (0.65)	0	0	1 (0.2)
	Rhodotorula mucilaginosa var mucilaginos	1 (0.65)	0	0	1 (0.2)

Table 2 Risk factors associated with fungal infections

Risk factors	2021 (n = 161)	2022 (n = 143)	2023 (n = 126)
Recent major surgery	18.5	20	15
Vascular 0 anastomosis	2	5	3
Necrotizing pancreatitis	0	2	4
Central venous catheters and other intravascular devices	89.4	92	90
Candida colonization	93.4	87	91
Exposure to broad spectrum antibiotics	98.7	95	96
Dialysis	17.2	15	19
Parenteral nutrition	76.8	81	77
Corticosteroids	32,4	42	35
Antifungal Rx	47.7	53	49

Table 3 Antifungal susceptibility for the most common fungal strains detected from patients with fungaemia

Candida species	Year	Number	Age (years)	Male:female	Death	Amphotericin B	5-fluorocytosine	Fluconazole	Voriconazole	Posaconazole	Itraconazole	Micafungin	Anidulafungin	Caspofungin
Candida albicans	2021	48	65.1 ± 18	0.7	89.5	100	N/A	87.5	79	68.2	75	13	21	100
	2022	24	71.6 ± 18.7	1.2:1	77.3	100	N/A	63.6	63.6	45.5	45.5	54.5	36.4	100
	2023	33	66.5 ± 15.6	1.5:1	80	100	N/A	52.3	71.4	66.6	36.4	13.6	13.6	100
	Total	103	66 ± 18.8	1:1	83	100	N/A	71	74.5	62.2	51	21.4	21	100
Candida tropicalis	2021	31	66.6± 14.7	1.9:1	89.6	100	N/A	15.7	10.5	5.5	10.5	N/A	0	0
	2022	29	65.6 ± 22	0.93	72	82	N/A	9	9	0	0	N/A	0	0
	2023	23	67.4 ± 19.4	1.1:1	92	100	N/A	0	0	0	0	0	0	0
	Total	83	67± 18.3	1.2:1	83	95.5	N/A	8.8	6.6	2.2	4.6	0	0	0
Candida parapsilosis	2021	27	61.2 ± 22.2	1.3:1	92	100	N/A	82	100	91	100	100	100	100
	2022	36	70.4 ± 14.9	1.1:1	87	100	N/A	68	95	95	95	100	100	100
	2023	29	61.7 ± 20.6	0.93:1	85.7	100	N/A	76.5	94	94	88.2	100	100	100
	Total	93	64.9 ± 196	1.1:1	88.5	100	N/A	75.7	95.6	93.7	93.2	100	100	100
Candida glabrata	2021	18	64.2 ± 13.7	2.2:1	94.7	100	N/A	0	N/A	N/A	N/A	100	54	54
	2022	7	70.6 ± 11.7	2.5:1	66.6	100	N/A	0	N/A	N/A	N/A	100	100	100
	2023	10	64.3	1:4	100	100	N/A	0	N/A	N/A	N/A	100	100	100
	Total	35	65.4 ± 15.4	1.25:1	88.8	100	N/A	0	N/A	N/A	N/A	100	64	64
Candida auris	2021	13	67.5 ± 21	1.2:1	100	100	N/A	0	N/A	N/A	N/A	87.5	87.5	87.5
	2022	38	72.4 ± 15.5	1.5:1	85.3	100	N/A	4	N/A	N/A	N/A	100	100	0
	2023	27	58.3 ± 18.9	0.93:1	100	100	N/A	0	N/A	N/A	N/A	100	100	4.5
	Total	78	66.6 ± 18.8	1.2:1	87.5	100	N/A	2	N/A	N/A	N/A	98	98	13.2