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Nosocomial Bloodstream Infection Due to Candida spp. in China: Species Distribution, Clinical Features, and Outcomes

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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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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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Author notes

    Authors and Affiliations

    1. Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853, China

      Ying Li, Liang-an Chen & Zhixin Liang

    2. Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, 100853, China

      Mingmei Du & Yunxi Liu

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    1. Ying Li
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    Correspondence to Zhixin Liang.

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    The authors have no declared conflict of interests.

    Ethical Approval

    This study was approved by the local institutional review board.

    Additional information

    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

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