title: Ten-year review of invasive Candida infections in a tertiary care center in Saudi Arabia.
abstract: OBJECTIVE
  To review the epidemiology of invasive Candida infections in a single center in Saudi Arabia over a subsequent 10-year period.
  
  
  METHODS
  This retrospective study was carried out in a single center in Saudi Arabia over a 10-year period. Records of all patients with invasive Candida infections (ICI) over the period from January 2003 to December 2012 were reviewed. Mann-Whitney U test was used for comparison of Candida albicans (C. albicans) versus non-albicans Candida species, and fluconazole resistance versus fluconazole susceptible in relation to crude mortality at 30 days and 90 days.
  
  
  RESULTS
  Eight hundred positive sterile site cultures, associated with 652 ICI were identified. Median age was 52 years and 53% of patients were males. Candida albicans were the most common species (38.7%), followed by Candida tropicalis (18.9%), and Candida glabrata (C. glabrata) (16.3%). The proportion of ICI caused by C. albicans remained stable over time (p=0.07), but C. glabrata increased significantly (p<0.001). The median rate of ICI per 1,000 hospital discharges per year was 1.65, with a significant trend towards higher rates over time (p=0.01). Most isolates were susceptible to fluconazole, voriconazole, and amphotericin B. Only 66.7% of Candida krusei were susceptible to caspofungin. Overall 30-day crude mortality was 40.6%. There was no significant difference in crude mortality in association with C. albicans compared with non-albicans species, nor in association with fluconazole resistance.
  
  
  CONCLUSIONS
  The rate of ICI increased significantly in the proportion of ICI caused by C. glabrata. Most isolates remain susceptible to caspofungin, voriconazole, and amphotericin B. The crude mortality remains high.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. Tel. +966 (11) 4777714 Ext. 25681. Fax. +966 (11) 4756711. E-mail. asomrani@gmail.com.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Omrani
authors.forename: Eyad A
authors.initials: EA
authors.lastname: Makkawy
authors.forename: Kamran
authors.initials: K
authors.lastname: Baig
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Baredhwan
authors.forename: Souad A
authors.initials: SA
authors.lastname: Almuthree
authors.forename: Noura A
authors.initials: NA
authors.lastname: Elkhizzi
authors.forename: Ali M
authors.initials: AM
authors.lastname: Albarrak
mesh_terms: D002177:Candidiasis / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D062606:Tertiary Care Centers