Epidemiology And Risk Factors For Short-term Outcomes Of Patients With Candida Bloodstream Infection

Objective Candida is important cause of nosocomial 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 Ruijin Hospital and estimate the impact of appropriate antifungal therapy and risk factors on the 30-day mortality.Methods From January 2008 to December 2015,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 30-day outcome were analyzed.The blood was cultured with BACTECTMFX automated blood culture system.The fungi were identified with API-32 C system.The susceptibility test was determined using the ANTIFUNGUS3,BioMerieux according to Clinical and Laboratory Standards Institute(CLSI).Statistical analysis was conducted by using the program SPSS 19.0.Results The incidence of nosocomial candida BSI was 3.54 episodes /10000 admissions in the present study.The overall 30-day mortality rate was 30.0%.The proportion of Candida BSI caused by C.non-albicans(62.7%),including C.parapsilosis(18.5%),C.tropicalis(15.5%),C.glabrata(12.9%),C.krusei(2.1%),C.guilliermondii(7.3%),C.sake(3.4%),was higher than that of C.albicans(37.3%).Among the 230 episodes of candida BSI,26.1%(60 cases)did not receive any antifungal agent,while73.9%(170 cases)received empiric antifungal therapy,of which only 67.0%(154cases)were considered appropriate.The mortality rate was significantly lower in those who received appropriate empiric antifungal therapy compared with those who received inappropriate antifungal therapy(P=0.005)within 5 d of the onset.Advanced age(OR=1.022,P=0.005),chronic renal failure(OR=2.114,P=0.015),mechanical ventilation(OR=1.760,P=0.045)and neutropenia(OR=5.816,P<0.001)were independent risk factors for the 30-day mortality,while male(OR=0.540,P=0.015),C.non-albicans infection(OR=0.512,P=0.01)and appropriate empiric antifungal therapy(OR=0.499,P=0.005)were protective factors against 30-day mortality.Conclusion Our retrospective study showed the incidence of candida BSI has increased in the past 8 years in Ruijin Hospital.However C.albicans remained the most frequently isolated species,while C.non-albicans increased deadly.30-day mortality in internal medicine wards was un-acceptably high.Finally,Male,candida species and appropriate empiric antifungal therapy influenced the short-term survival of patients with candida BSI.