A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

Zhangrui Zeng,Gang Tian,Guangrong Li,Yinhuan Ding,Jinbo Liu,Jian Deng,Kui Yang

doi:10.1186/s13756-020-00798-3

Abstract

BackgroundThere are no current national estimates of the candidaemia burden in China, and epidemiological candidaemia data from the underdeveloped region of China are lacking.MethodsA 7-year retrospective study was carried out to analyse the prevalence, species distribution, antifungal susceptibility, risk factors and inpatient mortality of candidaemia among paediatric and adult patients in a regional tertiary teaching hospital in China.ResultsDuring the seven-year study period, a total of 201 inpatients with candidaemia were identified. The median age of the patients was 65 years (range, 1 day to 92 years), and 114 of the patients (56.7%) were male. The mean annual incidence of candidaemia was 0.26 cases per 1000 admissions (0.42 cases per 1000 paediatric admissions vs 0.24 cases per 1000 adult admissions, P < 0.05). Candida albicans was the most common fungal species (81/201, 40.3%) in all patients, Candida glabrata was the most common fungal species (18/35, 51.4%) in paediatric patients. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.0%), and the activity of antifungal agents against Candida species was no significant difference in satisfaction between paediatric and adult patients (P > 0.05). The all-cause mortality rate was 20.4% (paediatric patients: 11.4% vs adult patients:22.3%, P > 0.05). Fewer univariate predictors of poor outcomes were identified for paediatric patients than for adult patients (4 vs 11 predictors). Respiratory dysfunction and septic shock were independent predictors of 30-day mortality for all patients.ConclusionsThe epidemiological data of candidaemia in paediatric and adult patients are only different in the distributions of Candida species and the mean annual incidence of candidaemia. Flucytosine and amphotericin B can be used as first-choice agents when no antifungal susceptibility test results are available.

Highlights

There are no current national estimates of the candidaemia burden in China, and epidemiological candidaemia data from the underdeveloped region of China are lacking
Candida albicans is the primary cause of candidaemia and one of the most common species in many countries, Candida glabrata is the second or third most common species in the United States of America (USA) and Europe, and Candida parapsilosis is predominant in neonates in South America, southern Europe and Asia [2]
The diagnostic criteria of candidaemia were based on the guidelines for the diagnosis and treatment of Candidiasis: the expert consensus issued by the Chinese Medical Association [12]; these criteria were in accordance with the European Society of Clinical Microbiology and Infectious Diseases (ESCMID)* guidelines for the diagnosis and management of Candida diseases 2012 [13, 14] and the Infectious Diseases Society of America (IDSA) Guidelines for the Management of Candidiasis: 2016 Update [15]

Summary

Introduction

There are no current national estimates of the candidaemia burden in China, and epidemiological candidaemia data from the underdeveloped region of China are lacking. The variability in the relative proportions of Candida isolates has been associated with clinical condition or risk factors such as age, underlying comorbidities, the extensive use of antifungal agents and geography. Candida albicans is the primary cause of candidaemia and one of the most common species in many countries, Candida glabrata is the second or third most common species in the USA and Europe, and Candida parapsilosis is predominant in neonates in South America, southern Europe and Asia [2]. The global incidence of candidaemia varies from 0.3 to 5 per 1000 admissions according to geographical region, local epidemiology, age and other factors [7]; the 30-day mortality among all patients with candidaemia has been reported to be between 22 and 70% [8], and the cost of candidaemia treatment has been reported to be US $40,000 per patient [1, 9, 10]

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Results

Conclusion