Prevalence of systemic candidiasis, drug-resistant Candida species, and associated factors among febrile patients with cancer at Uganda Cancer Institute

Abstract

Background: A significant proportion of cancer-related deaths in sub-Saharan Africa are secondary to infections. Patients with cancer are at risk of fungal infections due to their lowered immunity and when these infections are drug-resistant, the outcomes can be even worse. Data is urgently needed on the prevalence of systemic candidiasis, drug-resistant Candida species, and associated factors among cancer patients in Uganda. Objective: The primary objective was to determine the prevalence of systemic candidiasis, drug-resistant Candida species, and associated factors among febrile cancer patients admitted to the Uganda Cancer Institute (UCI). Secondarily, the study aimed to investigate the prevalence of bacteremia, antimicrobial susceptibility profiles, and associated factors. Methods: This cross-sectional study was conducted at UCI from March to May 2024. Convenience sampling was used to enroll all febrile cancer patients at admission or during their hospital stay until the sample size was reached. Blood cultures from these patients were performed, and microbial growth was identified. Antimicrobial susceptibility testing was conducted using the Kirby-Bauer disk diffusion method Results: A total of 123 participants, with a mean age of 43.0±16.0 years, were enrolled in the study. The cohort included 68 females (55.3%), 37 patients (30.1%) with hematological malignancies, and 86 patients (69.9%) with solid malignancies. None of the blood samples grew Candida or any fungal species. However, 18 (14.6%) blood samples grew bacteria; 10 (55.6%) Gram-negative bacilli and 8 (44.4%) Gram-positive cocci. E. coli (n=6, 60%) was the most isolated Gram-negative bacilli, and coagulase-negative Staphylococci (CoNS) (n=6, 75%) was the most isolated Gram-positive cocci. For coagulase-negative Staphylococci (CoNS), resistance to penicillin was 83.3% (n=5) and 66.7% (n=4) for cefoxitin, ciprofloxacin, erythromycin, and trimethoprim-sulphamethoxazole. For E. coli, 83.3% (n=5) of the isolates were resistant to cefotaxime, ceftazidime, ceftriaxone, and cefuroxime and 66.7% (n=4) to ciprofloxacin. There were no statistically significant factors associated with bacteremia in this study. Conclusions: The absence of Candida species in blood cultures may be influenced by the relatively low sensitivity of blood cultures in detecting candidemia, and the potential impact of prior antifungal therapy. The high resistance rates among bacterial isolates highlight the growing burden of antimicrobial resistance at UCI.