Epidemiological study of invasive nosocomial candidiasis in 2 teaching hospitals in Beijing

Abstract

To investigate the epidemiological characteristics of invasive nosocomial candidiasis in teaching hospitals in Beijing. The clinical data of consecutive cases diagnosed as with nosocomial candidiasis hospitalized in Beijing Chaoyang Hospital (CYH) (n=43) and Peking Union Medical College Hospital (PUMCH) (n=34) from January 2004 to September 2006 were retrospectively analyzed to evaluate the incidence and mortality, and the relationship between antifungal therapy and outcomes. The minimum inhibitory concentrations (MICs) for Candida spp were determined by microdilution method. The incidence rates of nosocomial candidiasis of CYH and PUMCH were 0.053% and 0.025% respectively in 2004, and increased to 0.074% and 0.049% respectively in 2006. Candidemia accounted for 55.8% (43/77) of the Candida infection, followed by intra-abdominal infection (26.0%, n=20), intra-thoracic infection (9.1%, n=7), and biliary tract infection (7.8%, n=6). The species mostly frequently isolated were Candida albicans (57.1%), followed by C. tropicalis (19.5%), C. glabrata (14.3%), and C. parasitosis (2.6%). The susceptibility rates of C. albicans, C. tropicalis, C. glabrata, and C. parasitosis to fluconazole were 97.7%, 86.7%, 63.6%, and 100% respectively. No isolates were resistant to amphotericin B. The crude mortality rate of Candida infection was 37.7%. The mortality rate of the candidemia patients who did not receive systemic antifungal therapy was 72.7%, significantly higher than those who received antifungal therapy (37.5%, P = 0.043). Most patients received fluconazole as the first choice (91.7% in PUMCH and 79.2% in CYH) with the survival rates of 63.6% and 52.6% respectively. Conclusion With high morbidity and mortality, invasive nosocomial candidiasis is a big problem in teaching hospitals. Further investigation is necessary to evaluate the incidence and to identify which antifungal agents are most protective for candidiasis.