Abstract
BackgroundWe evaluated the epidemiology, clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018.MethodsWe designed a retrospective observational study of adult patients with candidemia in a teaching hospital including three hospital campuses. Data regarding clinical and demographic characteristics were collected from the patient’s medical records.ResultsOf the 236 cases of candidemia, 172 (72.9%) were identified in surgical patients, including 146 (84.9%) general surgeries, 11 (6.4%) urologic surgeries, 6 (3.5%) thoracic surgeries, and others. Higher proportions of solid tumors, total parenteral nutrition, the presence of a urinary catheter, and the presence of a gastric tube were observed in surgical patients with candidemia versus non-surgical ones, whereas the percentages of hematological malignancy, diabetes mellitus, and renal replacement therapy were relatively lower in surgical patients. Renal failure, leukopenia, and thrombocytopenia were less common laboratory findings in surgical patients with candidemia than compared to non-surgical ones. Among surgical patients with candidemia, Candida parapsilosis was the predominant species (43%), followed by C. albicans (33.7%), C. glabrata (11%), C. tropicalis (8.1%), and others (4.1%). Overall susceptibility, susceptible dose dependent or intermediate susceptibility, and resistance to fluconazole were detected in 73.3, 19.8, and 3.5% Candida isolates from surgical patients, respectively, but no resistance to amphotericin B was observed. Overall, the 30-day mortality in surgical patients was 19.2%. At multivariable analysis, independent risk factors for death in surgical patients with candidemia were ICU stay, thrombocytopenia, and C. albicans infection.ConclusionsSurgical patients account for the majority of candidemia cases. Among patients with recent surgery, risk factors for species distribution, antifungal sensitivity patterns of Candida isolates causing candidemia, and independent risk factors for mortality should be evaluated and considered for a better outcome in the antifungal treatment.
Highlights
We evaluated the epidemiology, clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018
The previous prospective multicenter study conducted in surgical intensive care units (ICUs) has identified several risk factors independently associated with the increased risk of candidemia, including prior surgery, acute renal failure, receipt of parenteral nutrition, and, for postsurgical patients, presence of a triple lumen catheter [6]
Among surgical patients with candidemia, C. tropicalis isolates were more likely to occur in elderly patients (13.3% vs. 4.1%, P = 0.03) and in patients with diabetes mellitus (DM) (21.9% vs. 5%, P = 0.005) (Fig. 2B)
Summary
Clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018. Prior surgery has been demonstrated to one of the main risk factors of candidemia [6, 7]. The risk of occurrence of candidemia among patients who underwent a surgical procedure or had a central venous catheter (CVC) were 11 times higher than those who did not have a surgical procedure or a CVC [6]. The previous prospective multicenter study conducted in surgical intensive care units (ICUs) has identified several risk factors independently associated with the increased risk of candidemia, including prior surgery, acute renal failure, receipt of parenteral nutrition, and, for postsurgical patients, presence of a triple lumen catheter [6]
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