Abstract
Objectives
To investigate the distribution of Candida spp., predictors of mortality, and effects of therapeutic measures on outcomes of nosocomial bloodstream infection (BSI) due to Candida spp.
Methods
This retrospective, population-based study enrolled adult patients with Candida nosocomial BSI from January 2010 to December 2014 in one tertiary care hospital. The demographics, comorbidities, species distribution, risk factors, and effects of antifungal treatment were assessed.
Results
In total, 190 episodes of Candida BSI were identified. The most prevalent species was C. albicans (38.9 %), followed by C. parapsilosis (23.2 %) and C. tropicalis (20.5 %). In vitro susceptibility testing showed that 88.9 % of Candida isolates were susceptible to fluconazole. The 30-day hospital mortality was 27.9 %, while the early mortality (within 7 days) was 16.3 %. In a multivariate regression analysis, the Acute Physiology and Chronic Health Evaluation II score [odds ratio (OR) 1.23; 95 % confidence interval (CI) 1.080–1.390; P = 0.002] and severe sepsis or septic shock (OR 15.35; 95 % CI 2.391–98.502; P = 0.004) were independently correlated with early mortality. Severe sepsis or septic shock (OR 24.75; 95 % CI 5.099–120.162; P < 0.001) was an independent risk factor for 30-day mortality, while proven catheter-related candidemia (OR 0.16; 95 % CI 0.031–0.810; P = 0.027) was a positive factor for 30-day mortality. Early central venous catheter removal and adequate antifungal treatment were closely related to decreased mortality in patients with primary candidemia.
Conclusion
The proportion of candidemia caused by C. albicans was lower than that caused by non-albicans species. The severity of illness influenced early mortality, and the origin of the central venous catheter remarkably affected 30-day mortality.
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References
Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309–17.
Horn DL, Neofytos D, Anaissie EJ, et al. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48(12):1695–703.
Al TAH, Farahat FM, Al HMI, Al AAF, Perfect JR. Predictors and outcomes of Candida bloodstream infection: eight-year surveillance, western Saudi Arabia. Int J Infect Dis. 2014;21:5–9.
Garnacho-Montero J, Diaz-Martin A, Garcia-Cabrera E, de Pipaon MRP, Hernandez-Caballero C, Lepe-Jimenez JA. Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections. J Antimicrob Chemother. 2013;68(1):206–13.
Pfaller MA, Diekema DJ, Jones RN, et al. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and in vitro susceptibilities to fluconazole, ravuconazole, and voriconazole of isolates collected from 1997 through 1999 in the SENTRY antimicrobial surveillance program. J Clin Microbiol. 2001;39(9):3254–9.
Bassetti M, Merelli M, Righi E, et al. Epidemiology, species distribution, antifungal susceptibility, and outcome of candidemia across five sites in Italy and Spain. J Clin Microbiol. 2013;51(12):4167–72.
Milazzo L, Peri AM, Mazzali C, et al. Candidaemia observed at a university hospital in Milan (northern Italy) and review of published studies from 2010 to 2014. Mycopathologia. 2014;178(3–4):227–41.
Wu SX, Guo NR, Li XF, et al. Human pathogenic fungi in China—emerging trends from ongoing national survey for 1986, 1996, and 2006. Mycopathologia. 2011;171(6):387–93.
Wisplinghoff H, Ebbers J, Geurtz L, et al. Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities. Int J Antimicrob Agents. 2014;43(1):78–81.
Kim SH, Yoon YK, Kim MJ, Sohn JW. Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia. J Antimicrob Chemother. 2013;68(12):2890–7.
Kim SH, Yoon YK, Kim MJ, Sohn JW. Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections. Clin Microbiol Infect. 2013;19(1):62–8.
Garey KW, Rege M, Pai MP, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis. 2006;43(1):25–31.
Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503–35.
Parkins MD, Sabuda DM, Elsayed S, Laupland KB. Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections. J Antimicrob Chemother. 2007;60(3):613–8.
Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts: third informational supplement M27-S3.CLSI, Wayne, PA, USA, 2008.
Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of yeasts: 4th informational supplement M27-S4.CLSI, Wayne, PA, USA, 2012.
Rodriguez D, Park BJ, Almirante B, et al. Impact of early central venous catheter removal on outcome in patients with candidaemia. Clin Microbiol Infect. 2007;13(8):788–93.
Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.
Yang ZT, Wu L, Liu XY, et al. Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai. BMC Infect Dis. 2014;14:241.
Bassetti M, Taramasso L, Nicco E, et al. Epidemiology, species distribution, antifungal susceptibility and outcome of nosocomial candidemia in a tertiary care hospital in Italy. PLoS One. 2011;6(9):e24198.
Arendrup MC, Dzajic E, Jensen RH, et al. Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme. Clin Microbiol Infect. 2013;19(8):E343–53.
Garnacho-Montero J, Diaz-Martin A, Garcia-Cabrera E, et al. Risk factors for fluconazole-resistant candidemia. Antimicrob Agents Chemother. 2010;54(8):3149–54.
Cornely OA, Bassetti M, Calandra T, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18(Suppl 7):19–37.
Almirante B, Rodriguez D, Cuenca-Estrella M, et al. Epidemiology, risk factors, and prognosis of Candida parapsilosis bloodstream infections: case-control population-based surveillance study of patients in Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2006;44(5):1681–5.
Malani A, Hmoud J, Chiu L, Carver PL, Bielaczyc A, Kauffman CA. Candida glabrata fungemia: experience in a tertiary care center. Clin Infect Dis. 2005;41(7):975–81.
Malani AN, Psarros G, Malani PN, Kauffman CA. Is age a risk factor for Candida glabrata colonisation. Mycoses. 2011;54(6):531–7.
Nucci M, Anaissie E. Should vascular catheters be removed from all patients with candidemia? An evidence-based review. Clin Infect Dis. 2002;34(5):591–9.
Limper AH, Knox KS, Sarosi GA, et al. An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011;183(1):96–128.
Acknowledgments
The collection, analysis, and interpretation of data in this work were supported by Research Support Foundation, Military health and disease prevention and control research (13BJYZ32).
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The authors have no declared conflict of interests.
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This study was approved by the local institutional review board.
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Ying Li and Mingmei Du have contributed equally to this work.
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Li, Y., Du, M., Chen, La. et al. Nosocomial Bloodstream Infection Due to Candida spp. in China: Species Distribution, Clinical Features, and Outcomes. Mycopathologia 181, 485–495 (2016). https://doi.org/10.1007/s11046-016-9997-3
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DOI: https://doi.org/10.1007/s11046-016-9997-3