Epidemiology,clinical Features And Prognostic Risk Factors Of Candida Bloodstream Infections

Objective:To investigate the epidemiology,clinical characteristics and risk factors related to prognosis of patients with Candida bloodstream infections(CBI),in order to provide the basis for identification of high-risk patients and rational drug use.Methods:Taking the patients with positive candida blood culture in our hospital from January 2019 to Deceber 2021 as the research object,find and collect relevant clinical data from the hospital′s public system,and analyze flora and department distribution,durg resistance and possible association with Prognosis-related risk factors,and binary Logistic regression was used to analyze the independent risk factors of death patients.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of procalcitonin(PCT)level within 48 hours after the first positive blood culture specimen collection for prognosis.Results:1.Among the 103 patients included,there were 65 males(63.1%)and 38females(36.9%),and the average hospital stay was(44.15±30.52)days.The 28-day fatality rate was 31.07%(32/103).Among the 109 isolated Candida strains,39 strains(35.8%)of Candida parapsilosis surpassed 35 strains(32.1%)of Candida albicans to become the main pathogenic bacteria.The top two in the ward distribution were 68strains(62.4%)in the intensive care unit(ICU)and 14 strains(12.9%)in the department of hematology.Most of them were elderly patients(49/103,accounting for47.5%).2.Binary Logistic regression showed independent risk factors:(1-3)-β-D glucan(Plasma(1-3)-β-D glucan,BDG)>10pg/ml,septic shock,renal insufficiency,Indwelling central venous catheter,history of vascular stent implantation,PCT.Removal of CVC within 48 hours after positive blood culture is beneficial to prognosis.3.Patients with non-albicans candidemia had a longer hospital stay than those with candidemia albicans,and the differences in PCT,creatinine(CR),and absolute neutrophil count(ANC)were statistically significant,but there was no difference in prognosis.4.The resistance rates of C.parapsilosis,C.albicans,C.tropicalis,and C.glabrata to caspofungin were 2.5%,2.8%,4.5%,and 0%,respectively;the resistance rates to fluconazole were 17.9%,respectively,0%,31.8%,25%;the sensitivity rate to 5-fluorocytosine and amphotericin B was 100%.5.The area under the cure(AUC)of the ROC curve established by PCT was0.754,the optimal cutoff value was 1.185,and the sensitivity was 81.3%,the specificity was 63.4%,the misdiagnosis rate was 18.7%,and the negative predictive value was 88.2%.The established prognostic score table has good diagnostic value for prognosis.Conclusions:1.The proportion of bloodstream infections caused by non-albicans Candida exceeds that of Candida albicans,and the hospitalization time is longer;The distribution of CBI departments is mainly ICU and hematology department.2.BDG>10pg/ml,septic shock,Indwelling central venous catheter,history of vascular stent implantation,PCT,and renal insufficiency are independent risk factors for prognosis of patients.Removal of CVC within 48 hours of positive blood culture is beneficial for prognosis.3.Non-albicans Candida has a low resistance rate to echinocandins and a high resistance rate to azoles.Echinocandins are recommended for preventive treatment.4.The PCT level within 48 hours after the collection of the first blood culture positive specimen and the established prognostic score table have good diagnostic value for prognosis.