Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

Yan-Jun Zheng,Xiao-Ying Liu,Li-Zhong Han,Ling Zhu,Er-Zhen Chen,Zhi-Tao Yang,En-Qiang Mao,Ting Xie,Ying Chen,Lin Wu

doi:10.1186/s12941-021-00441-y

Abstract

BackgroundThe incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes.MethodsAll consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed.ResultsAmong the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not.ConclusionsThe incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

Highlights

The incidence of Candida bloodstream infections (BSIs), has increased over time
The incidence of invasive fungal infection has increased over time, especially for Candida bloodstream infections (BSIs), which is associated with considerable excess mortality and costs [1,2,3]
Incidence and clinical features of Candida BSI episodes Data on a total of 393 consecutive episodes of Candida BSI were collected from 370 inpatients during the 11-year study period

Summary

Introduction

The incidence of Candida bloodstream infections (BSIs), has increased over time. The incidence of invasive fungal infection has increased over time, especially for Candida bloodstream infections (BSIs), which is associated with considerable excess mortality and costs [1,2,3]. In the past two decades, the incidence of fungal infection has increased from 0.1 episodes/1000 admissions to 0.3–0.6 episodes/1000. The optimal management of Candida BSIs includes early awareness of patients at risk, control of the infection source, and timely administration of appropriate antifungal agents [12, 13]. Several studies showed that delayed antifungal therapy (more than 48 h from onset) is associated with higher mortality [14], whereas others have reported conflicting results [15,16,17]

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