Candidemia after cardiac surgery in Tehran, Iran: A retrospective analysis of 424 cases at two medical centers

Abstract

Background: Candidaemia is an emerging problem and one of the most important nosocomial infections in many hospitals. The aim of this study was to characterize the epidemiology and patient outcomes of candidemia after cardiac surgery at two medical centers in Iran over a nine-year period.

Methods: A retrospective analysis was conducted reviewing the medical records of all patients who underwent surgical treatment of cardiac disease at two medical centers. Demographic data, comorbidities, surgical procedure, length of hospital stay, odds ratio and annual trend for candidemia in cardiosurgical cases were collected and analyzed.

Results: Candidemia was responsible for 1.78% cases of total cardiac surgeries (23,849) in two hospitals. Data showed an overall declining trend for the incidence of candidemia during the study period, so that decreased from 3.81% in 2003–2004 to 0.52% in 2011–2012 (P < .01). The odds ratio was significantly downward (from 1 to 0.14, P < .01). Candidemia had a direct relationship with patiant age, and the mean age was 64.2 years. A remarkable gender difference skewed towards males was observed, and the male/female ratio among candidemia cases <60 and ≥65 years old was 0.82 and 1.79, respectively. Housewives had the highest rate of infection (34.91%). Coronary Artery Bypass Graft was the most common type of surgical intervention. Majority of candidemia patients (89.2%) had risk factor and the most common comorbidities were diabetes. Mean total hospital stay was 17.34 ± 4.69 days.

Conclusions: This study expands the knowledge of the epidemiology and trend of incidence of candidemia in cardiosurgical cases. The survey provides preliminary baseline data for the future monitoring of candidemia, and effective programs for controlling and preventive strategies against the disease in hospitals.

Keywords: Candidemia, Candida, Cardiac surgery, Epidemiology, Predisposing factor, Iran