Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality

Guangwen Xiao,Yuenong Zhang,Guodan Li,Yunyao Xu,Yingping Yang,Wanqing Liao,Cailing Zhang,Xiaodong Luo

doi:10.1186/s12879-020-05291-1

Abstract

BackgroundFungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China.MethodsEighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and ROC curve analysis were used to assess the risk factors for mortality among the cases.ResultsThe prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 36% (29/81). Ninety-eight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (43%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs. Logistic multiple regression showed that age, serum albumin, APACHE II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤25 g/L were the best predictors of mortality.ConclusionCandida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and concurrently monitor fungal susceptibility to reduce mortality rates.

Highlights

Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing
These rates appear to coincide with more widespread use of broad-spectrum antifungal drugs, glucocorticoids, and immunosuppressive agents, as well as the low immunity of ICU patients and use of central venous catheter technology and other invasive procedures; early symptoms of fungal bloodstream infection lack specificity, and low culture-positive rates can lead to a misdiagnosis [11]
Wald χ2, chi-squared test value; OR odds ratio, CI confidence interval with fungal bloodstream infections. After subjecting these variables to Receiver operating characteristics (ROC) analysis, the results showed that when the Acute Physiology and Chronic Health Evaluation (APACHE) Acute physiology and chronic health evaluation II (II) score was > 19, the area under the curve (AUC) was 0.801, and when serum albumin was ≤25 g/L, AUC was 0.636, which indicated that these were the best predictors for mortality among fungal bloodstream infection patients (Fig. 2)

Summary

Introduction

Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. The incidence of fungal bloodstream infections caused by pathogens such as Candida spp. has increased in recent years, especially in intensive care units (ICUs) [1, 2]. Studies have shown that the incidence of fungal bloodstream infections in ICUs is 0.22–4.1% in developing countries [4,5,6,7] and 0.024–0.687% in developed countries [8,9,10]. There were several studies on the pathogens and infection risk factors of fungal bloodstream infection and relatively few studies on the risk factors for the mortality of the patients

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