IntroductionCandidaemia is a widely studied and reviewed in the

developed world, however there is lack of information on

nosocomial candidaemia in Nigeria despite the increasing

use of more therapeutic modalities in patient management

and the increasing incidence of immunosuppression due to

HIV/AIDS, neoplastic disease and use of

immunosuppressive agents. The objective of this study was

to determine the prevalence of candidaemia, estimate the

mortality rates and identify factors associated with

candidaemia amongst immunosuppressed patients with

persistent fever admitted in University College Hospital,

Ibadan

Materials & MethodsVenous blood was collected following standard protocols from 230

immunosuppressed patients with persistent fever while receiving

adequate antibacterial coverage and incubated at 37oC using

BACTEC 9050. Positive samples were examined microscopically

using direct gram staining; those showing yeasts were cultured onto

Sabourauds agar and CHROMagar Candida. Germ tube was

performed on all yeasts for the presumptive identification of C.

albicans and all isolates were identified to species level using

API20AUX and API32C. The susceptibility of all isolates to

Amphotericin B, Flucytosine, Fluconazole, Itraconazole,

Voriconazole, Posaconazole and Caspofungin was performed by

both the CLSI and EUCAST method. Clinical details of the

patients were entered into a semi-structured pro-forma form

incorporating socio-demographic data, medical/surgical history of

known risk factors for Candidaemia and other laboratory findings

for Candida and analysed using SPSS 13.0 software.

Results Candidaemia, the 3rd most common isolate recovered from blood

was detected in twelve patients, a prevalence of 5.2%. Time to

positive culture was 1 to 7 (mean 3.5) days. The species isolated were

C. parapsilosis 4 (33.3%); C. tropicalis 6 (50.0%); C. albicans 1

(8.3%); and mixed infection of C. albicans and C. tropicalis 1 (8.3%).

CHROMagar Candida failed to identify all the species whereas both

API20AUX and API32C gave the same result. The susceptibility

data were similar between the two methods and in accordance to

published data for each drug and species.

Multivariate analysis using logistic regression and correlation

revealed that apart from blood and stool Candida spp isolated from

intravenous cut down (P=0.040), mucositis (P=0.019) and diarrhoea

(P=0.017) were significantly associated with increased risk of

development of Candidaemia, while univariate analysis showed that

old age, multiple surgeries and long term hospitalisation were

significant contributing factors. There was 91.7% crude (11/12

patients) and 50% attributable mortality.

Conclusion:

These findings prove that Candidaemia may be the

cause of persistent fever in immunosuppressed patients

that are not on prophylaxis or empiric antifungal

therapy. The high mortality rate which must be directly

related to the delay in commencing treatment should

facilitate development of rational approaches for

prevention, early identification and appropriate

management of those patients at risk of developing this

life-threatening condition. Furthermore it highlights

the importance of prompt antifungal treatment and the

availability of new oral and intravenous drug in

hospital pharmacies, as at present our patients can only

be treated with oral Fluconazole as no other drug is

available, and the need for further studies in these

susceptible populations.

4th Trends in Medical Mycology (TIMM) Hotel Hilton, Athens, Greece, 18th – 21st October 2009

Prevalence of Candidaemia in University College Hospital IbadanOladele RO1, Petrou MA2 & Bakare R1

1Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan, Nigeria; 2Department of Medical Mycology, Imperial Healthcare NHS Trust, London, United KingdomP095

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