Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai
BMC Infectious Diseases
Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai
Zhi-Tao Yang 0 1 4
Lin Wu 0 3
Xiao-Ying Liu 1
Min Zhou 8
Jie Li 8
Jia-Yin Wu 7
Yong Cai 6
En-Qiang Mao 1
Er-Zhen Chen 1
Olivier Lortholary 2 5 9
0 Equal contributors
1 Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine , No. 197 Ruijin Er Road, Shanghai 200025 , China
2 Université Paris Descartes, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d'Infectiologie Necker Pasteur, IHU Imagine , 149, rue de Sèvres, 75743 Paris Cedex 15 , France
3 Geriatric Department, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine , No. 197 Ruijin Er Road, Shanghai 200025 , China
4 Pôle Sino-Français de Recherches en Science du Vivant et Génomique, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine , No. 197 Ruijin Er Road, Shanghai 200025 , China
5 Université Paris Descartes, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d'Infectiologie Necker Pasteur, IHU Imagine , 149, rue de Sèvres, 75743 Paris Cedex 15 , France
6 Public Health Institute, Shanghai Jiaotong University, School of Medicine , No. 227 Chongqing Nan Road, Shanghai 200025 , China
7 Informatics Department, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine , No. 197 Ruijin Er Road, Shanghai 200025 , China
8 Clinical Microbiology Department, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine , No. 197 Ruijin Er Road, Shanghai 200025 , China
9 Institut Pasteur, Centre National de Référence Mycologie et Antifongiques , CNRS URA3012, Paris , France
Background: Yeasts, mostly Candida, are important causes of bloodstream infections (BSI), responsible for significant mortality and morbidity among hospitalized patients. The epidemiology and species distribution vary from different regions. The goals of this study were to report the current epidemiology of Candida BSI in a Shanghai Teaching Hospital and estimate the impact of appropriate antifungal therapy on the outcome. Methods: From January 2008 to December 2012, all consecutive patients who developed Candida BSI at Ruijin University Hospital were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy and its impact on the outcome were analyzed. Results: A total of 121 episodes of Candida BSI were identified, with an incidence of 0.32 episodes/1,000 admissions (0.21 in 2008 and 0.42 in 2012) The proportion of candidemia caused by non-albicans species (62.8%), including C. parapsilosis (19.8%), C. tropicalis (14.9%), C. glabrata (7.4%), C. guilliermondii (5.8%), C. sake (5.0%) was higher than that of candidemia caused by C. albicans (37.2%). The overall crude 28-day mortality was 28.1% and significantly reduced with appropriate empiric antifungal therapy administered within 5 days (P = 0.006). Advanced age (OR 1.04; P = 0.014), neutropenia < 500/mm3 (OR 17.44; P < 0.001) were independent risk factors for 28-day mortality, while appropriate empiric antifungal therapy (OR 0.369; P = 0.035) was protective against 28-day mortality. Conclusion: The epidemiology of candidemia in Shanghai differed from that observed in Western countries. Appropriate empiric antifungal therapy influenced the short-term survival.
Candida spp; Bloodstream infection; Appropriate antifungal therapy; Survival
Background
Yeasts, mostly Candida spp. are currently between the
fourth and the sixth most common nosocomial
bloodstream isolate in American and European studies [
1,2
].
However, their incidences vary according to geography
but overall continue to increase worldwide [
3-6
] except
in North America and China [
4,7,8
]. Risk factors include
exposure to broad-spectrum antibacterial agents, increased
complexity of surgical procedures, prolonged use of central
venous catheters, dialysis, corticosteroids and cytotoxic
chemotherapy [
9
].
Although C. albicans has long been the most common
species isolated during candidemia, recent studies have
demonstrated a shift towards non-albicans species, such as
C. parapsilosis, C. glabrata and C. krusei [
3,10
], especially
in intensive care unit and hematological patients [
11-13
]
and/or in case of antifungal pre-exposure [
14,15
].
Guidelines on the treatment of candidemia have been developed
[
16,17
], with a consensus that all candidemic patients
should receive antifungal therapy. Although novel
antifungal drugs have been developed since the last decade,
90-day mortality rates due to candidemia remain as high
as 50-70% [
12,18,19
]. In addition, data from several
studies showed that 30-day mortality rates and costs of
care increased significantly when empirical therapy was
delayed or inadequate (inappropriate dosage, resistant
isolate) [
20-24
].
We provide herein a laboratory-based report from (...truncated)