Survival Outcomes in Invasive Candidiasis: Exploring the Role of Chronic Disease Prevention and Healthy Lifestyle in Malaysia
Main Article Content
Abstract
Invasive candidiasis (IC) is a life-threatening fungal infection, particularly prevalent among patients with non-communicable diseases (NCDs). The rising incidence of NCDs in Malaysia poses a significant challenge to IC management and patient survival. Objective of this study was to determine the median survival time of IC patients in Malaysia and explore the relationship between survival outcomes, chronic disease prevention.
This retrospective cohort study analyzed data from 445 patients diagnosed with IC at a tertiary hospital in Malaysia. Data on sociodemographics, comorbidities, clinical presentation, Candida species, treatment and patients outcome were collected and analysed using Kaplan-Meier survival estimates.
The median survival time for IC patients was 21 days, with significant variations based on age, ethnicity, and comorbidities. Patients with diabetes on insulin therapy exhibited a lower mortality risk, likely due to better glycemic control and higher health-seeking behavior. Candida parapsilosis infections were associated with higher survival rates, while Candida glabrata and Candida tropicalis infections were linked to poorer outcomes. These findings highlight the importance of tailored treatment strategies that consider patient comorbidities and the specific Candida species involved. Integrating preventive measures for NCDs and promoting healthy lifestyle practices are crucial for improving IC patient survival
Article Details

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Cahan, H., & Deville, J. G. (2011). Outcomes of Neonatal Candidiasis: The Impact of Delayed Initiation of Antifungal Therapy. International Journal of Pediatrics, 2011, 1–6. https://doi.org/10.1155/2011/813871
Chávez-Reyes, J., Escárcega-González, C. E., Chavira-Suárez, E., León-Buitimea, A., Vázquez-León, P., Morones-Ramírez, J. R., Villalón, C. M., Quintanar-Stephano, A., & Marichal-Cancino, B.
A. (2021). Susceptibility for Some Infectious Diseases in Patients With Diabetes: The Key Role of Glycemia. In Frontiers in Public Health (Vol. 9). Frontiers Media S.A. https://doi.org/10.3389/fpubh.2021.559595
Elbaz, M., Chikly, A., Meilik, R., & Ben-Ami, R. (2022). Frequency and Clinical Features of Candida Bloodstream Infection Originating in the Urinary Tract. Journal of Fungi, 8(2). https://doi.org/10.3390/jof8020123
Geerlings, S. E., & Hoepelman, A. I. M. (1999). Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunology & Medical Microbiology, 26(3–4), 259–265. https://doi.org/10.1111/j.1574-695X.1999.tb01397.x
Ghrenassia, E., Mokart, D., Mayaux, J., Demoule, A., Rezine, I., Kerhuel, L., Calvet, L., De Jong, A., Azoulay, E., & Darmon, M. (2019). Candidemia in critically ill immunocompromised patients: report of a retrospective multicenter cohort study. Annals of Intensive Care, 9(1). https://doi.org/10.1186/s13613-019-0539-2
Gong, Y., Li, C., Wang, C., Li, J., Ding, M., Chen, D., & Lao, M. (2020). Epidemiology and mortality-associated factors of invasive fungal disease in elderly patients: A 20-year retrospective study from Southern China. Infection and Drug Resistance, 13, 711–723. https://doi.org/10.2147/IDR.S242187
Hohmann, F. B., Chaves, R. C. de F., Olivato, G. B., Souza, G. M. de, Galindo, V. B., Silva, M., Martino, M. D. V., Menezes, F. G. de, & Corrêa, T. D. (2023). Characteristics, risk factors, and outcomes of bloodstream Candida infections in the intensive care unit: a retrospective cohort study. Journal of International Medical Research, 51(1). https://doi.org/10.1177/03000605221131122
Horn, D. L., Ostrosky-Zeichner, L., Morris, M. I., Ullmann, A. J., Wu, C., Buell, D. N., Kovanda, L. L., & Cornely, O. A. (2010). Factors related to survival and treatment success in invasive candidiasis or candidemia: A pooled analysis of two large, prospective, micafungin trials. European Journal of Clinical Microbiology and Infectious Diseases, 29(2), 223–229. https://doi.org/10.1007/s10096-009-0843-0
Hsu, J. F., Lai, M. Y., Lee, C. W., Chu, S. M., Wu, I. H., Huang, H. R., Lee, I. T., Chiang, M. C., Fu,
R. H., & Tsai, M. H. (2018). Comparison of the incidence, clinical features, and outcomes of invasive candidiasis in children and neonates. BMC Infectious Diseases, 18(1). https://doi.org/10.1186/s12879-018-3100-2
Ismail, N., Said, R., Ismail, N. W., & Haron, S. A. (2024). Non-Communicable Diseases Impact Low-Income Households in Malaysia. Malaysian Journal of Medical Sciences, 31(1), 124–139. https://doi.org/10.21315/mjms2024.31.1.11
Kanj, S. S., Omrani, A. S., Al-Abdely, H. M., Subhi, A., Fakih, R. El, Abosoudah, I., Kanj, H., & Dimopoulos, G. (2022). Survival Outcome of Empirical Antifungal Therapy and the Value of Early Initiation: A Review of the Last Decade. In Journal of Fungi (Vol. 8, Issue 11). MDPI. https://doi.org/10.3390/jof8111146
Keighley, C., Kim, H. Y., Kidd, S., Chen, S. C. A., Alastruey, A., Dao, A., Bongomin, F., Chiller, T., Wahyuningsih, R., Forastiero, A., Al-Nuseirat, A., Beyer, P., Gigante, V., Beardsley, J., Sati, H., Morrissey, C. O., & Alffenaar, J. W. (2024). Candida tropicalis-A systematic review to inform the World Health Organization of a fungal priority pathogens list. In Medical Mycology (Vol. 62, Issue 6). Oxford University Press. https://doi.org/10.1093/mmy/myae040
Khaw, W. F., Chan, Y. M., Nasaruddin, N. H., Alias, N., Tan, L. A., & Ganapathy, S. S. (2023). Malaysian burden of disease: years of life lost due to premature deaths. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16309-z
Kutlu, M., Sayın-Kutlu, S., Alp-Çavuş, S., Öztürk, Ş. B., Taşbakan, M., Özhak, B., Kaya, O., Kutsoylu, O. E., Şenol-Akar, Ş., Turhan, Ö., Mermut, G., Ertuğrul, B., Pullukcu, H., Çetin, Ç. B., Avkan-Oğuz, V., Yapar, N., Yeşim-Metin, D., & Ergin, Ç. (2022). Mortality-associated factors of candidemia: a multi-center prospective cohort in Turkey. European Journal of Clinical Microbiology and Infectious Diseases, 41(4), 597–607. https://doi.org/10.1007/s10096- 021-04394-0
Nyunt, T. P. K., Mullol, J., & Snidvongs, K. (2020). Immune response to fungi in diabetic patients with invasive fungal rhinosinusitis. In Asian Pacific Journal of Allergy and Immunology (Vol. 38, Issue 4, pp. 233–238). Allergy and Immunology Society of Thailand. https://doi.org/10.12932/AP-080620-0874
Pappas, P. G., Lionakis, M. S., Arendrup, M. C., Ostrosky-Zeichner, L., & Kullberg, B. J. (2018). Invasive candidiasis. Nature Reviews Disease Primers, 4. https://doi.org/10.1038/nrdp.2018.26
Roberts, T., Luangasanatip, N., Ling, C. L., Hopkins, J., Jaksuwan, R., Lubell, Y., Vongsouvath, M., van Doorn, H. R., Ashley, E. A., & Turner, P. (2021). Antimicrobial resistance detection in Southeast Asian hospitals is critically important from both patient and societal perspectives, but what is its cost? PLOS Global Public Health, 1(10). https://doi.org/10.1371/journal.pgph.0000018
Soriano, A., Honore, P. M., Puerta-Alcalde, P., Garcia-Vidal, C., Pagotto, A., Gonçalves-Bradley, D. C., & Verweij, P. E. (2023). Invasive candidiasis: current clinical challenges and unmet needs in adult populations. In Journal of Antimicrobial Chemotherapy (Vol. 78, Issue 7, pp. 1569– 1585). Oxford University Press. https://doi.org/10.1093/jac/dkad139
Velayuthan, R. D., Samudi, C., Singh, H. K. L., Ng, K. P., Shankar, E. M., & Denning, D. W. (2018). Estimation of the burden of serious human fungal infections in Malaysia. Journal of Fungi, 4(1). https://doi.org/10.3390/jof4010038
Zhang, Z., Zhao, L., Zhou, X., Meng, X., & Zhou, X. (2023). Role of inflammation, immunity, and oxidative stress in hypertension: New insights and potential therapeutic targets. In Frontiers in Immunology (Vol. 13). Frontiers Media S.A. https://doi.org/10.3389/fimmu.2022.1098725