Antibiotic Factors and Candidemia Origins

We performed a retrospective, matched, case-control study in two university-affiliated tertiary hospitals in South Korea from January 2019 to August 2020 (Samsung Changwon Hospital, 760-bed; Inje University Busan Paik Hospital, 818-bed). Patients (age ≥ 18 years) with candidemia were included if they had at least one positive blood culture for Candida species. For each case, one control matched for age (±5 years), duration of hospitalization, hospital ward (intensive care unit (ICU)/non-ICU), and type of surgery was identified within the same hospital [12 (link)]. Duration of hospitalization in the cases was calculated as the time from the day of admission to the day of collection of the first positive blood culture with Candida species. Matched controls remained hospitalized for the equivalent time and did not develop candidemia during hospitalization. The hospital ward was assessed based on the index date (day of occurrence of candidemia in the cases or matched day in the controls). Surgical procedures within the four weeks before the index date was identified and classified as no surgery, hepatobiliary/gastrointestinal surgery, genitourinary surgery, other abdominal/pelvic surgery, cardiothoracic surgery, or other major surgery [10 (link)]. Patients who had neutropenia (absolute neutrophil count of <500 cells/mm³) or for whom we could not identify previous antibiotic therapy were excluded. Moreover, we excluded cases for which matched control patients could not be identified. The primary objective was to identify antibiotic factors associated with candidemia. The secondary objective was to identify differences in antibiotic factors according to the origins of candidemia, and the origins of candidemia were classified into catheter-related bloodstream infection (CRBSI) and non-CRBSI. The study was approved by the Samsung Changwon Hospital and Busan Paik Institutional Review Boards (IRB numbers: SCMC 2021-08-005 and BPIRB 2021-08-051).