• Nesrin Ghanem-Zoubi, Johad Khoury, Merav Arnon, Danny Zorbavel, Yuval Geffen, and Mical Paul.
• Institute of Infectious Diseases, Rambam Health Care Campus, affiliated with Technion-Israel Institute of Technology, Haifa, Israel.
• Isr Med Assoc J. 2019 May 1; 21 (5): 303-307.

BackgroundWith the widespread use of antifungal agents, the frequency of non-albicans Candida (NAC) blood-stream infections (BSI) is increasing.ObjectivesTo describe the epidemiology, clinical manifestations, and risk factors for NAC BSI, focusing on prior antifungal and immunosuppressive therapy.MethodsThe authors conducted an observational, retrospective cohort study among adult patients with candidemia at the Rambam Health Care Campus, a tertiary medical center in Israel, between 2009 and 2015. Comparisons between patients with Candidemia albicans and NAC candidemia were performed. Regression analysis, with NAC BSI as the dependent variable and significant risk factors for NAC as independent variables, was performed.ResultsA total of 308 episodes of candidemia were included. C. albicans was isolated in 30.8% of patients (95/308), while NAC spp. were isolated in the rest. Significant independent risk factors for NAC included immunosuppression therapy (odds ratio [OR] 0.38, 95% confidence interval [95%CI] 0.19-0.76) and previous azole use (OR 0.2, 95%CI 0.06-0.710). The interaction between prior azole and immunosuppression therapy in the model was not significant, and after its inclusion in the model only immunosuppression remained significantly associated with NAC. In the subgroup of patients who did not receive prior azoles, immunosuppression therapy, neutropenia, and bone marrow transplantation were significantly associated with NAC.ConclusionsIndependent of previous azole treatment, immunosuppressive therapy was a significant risk factor for NAC in our cohort.

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