title: Ten-year review of candidemia in a Canadian tertiary care centre: Predominance of non-albicans Candida species.
abstract: OBJECTIVE
  To review the epidemiology and associated risk factors for candidemia at a tertiary care centre, in view of recent reports on the changing epidemiology of bloodstream infection due to Candida species.
  
  
  METHODS
  Between January 2000 and December 2009, patients with blood culture samples positive for Candida species were identified using the microbiology laboratory information system. Patient data were collected by retrospective chart review of clinical characteristics including demographic data, underlying medical diagnoses and risk factors.
  
  
  RESULTS
  A total of 266 candidemia episodes were included in the final analysis. Fifty-nine per cent of these episodes occurred in males and 51% were in patients >60 years of age. The most common risk factor for candidemia was previous antibiotic use (85%). The most frequent species was Candida albicans (49%), followed by Candida glabrata (30%). C albicans was the predominant species in all study years with the exception of 2002, in which C glabrata was more frequent. The likelihood of recovering a non-albicans Candida species was found to be significantly associated with previous antifungal therapy (P=0.0004), immunosuppressive therapy (P=0.002), abdominal surgery (P=0.003) and malignancy (P=0.05). Mixed candidemia was found in 10 episodes (4%); 80% grew C albicans and C glabrata. Risk factors for mixed candidemia were not significantly different from those with monomicrobial candidemia.
  
  
  CONCLUSIONS
  C albicans remains the most commonly isolated species in this setting, consistent with findings from other Canadian centres. However, non-albicans Candida species were overall predominant. Mixed-species candidemia does not appear to be more prevalent in patients with identified risk factors.
authors.affiliation: Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia; ; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia;
authors.forename: Ghada N
authors.initials: GN
authors.lastname: Al-Rawahi
authors.affiliation: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia; ; Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Roscoe
keywords: Candidemia; Epidemiology; Risk factors