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Mycopathologia

, Volume 183, Issue 4, pp 679–689 | Cite as

Candidemia in Adults at a Tertiary Hospital in China: Clinical Characteristics, Species Distribution, Resistance, and Outcomes

  • Shaoming Lin
  • Ruilan Chen
  • Song Zhu
  • Huijun Wang
  • Lianfang Wang
  • Jian Zou
  • Jingdong Yan
  • Xiangdong Zhang
  • Dimitrios Farmakiotis
  • Xiaojiang Tan
  • Eleftherios Mylonakis
Original Paper

Abstract

Background

Candidemia is one of the most common nosocomial bloodstream infections. Early diagnosis and antifungal treatment improve clinical outcomes in some studies but not all, with diverse data reported from different institutions. Similarly, antifungal resistance is more common in the USA than in Europe, but there is little data regarding the microbiology and clinical course of candidemia in adult patients in Asia.

Aims

(1) To capture species distribution and drug resistance rates among Candida bloodstream isolates, (2) to describe clinical features of candidemia, and (3) to identify factors associated with all-cause mortality, with emphasis on early initiation of antifungal treatment, at a large tertiary University Hospital in China.

Methods

In this single-center retrospective study, we identified all patients with candidemia, between 2008 and 2014. Demographic and clinical characteristics, microbiological information, details of antifungal therapy and clinical outcomes were collected.

Results

We studied 166 patients. 71 (42.8%) had cancer. Candida albicans was the most frequent species (37.3%), followed by C. parapsilosis (24.1%), C. tropicalis (22.8%), and C. glabrata (14.5%). Antifungal resistance was more frequent in non-albicans strains and especially C. glabrata. Twenty patients received inappropriate treatment with all-cause mortality of 35%. The remaining 146 patients had significantly lower mortality (21.9%, P = 0.045). Among patients who received antifungal treatment, mortality rate increased with time to appropriate antifungal therapy (AAT): 13.7%, for < 24 h, 21.1% for 24–48 h, 23.1% for > 48 h, and 32.4% among patients who received no AT (χ2 for trend P = 0.039). Initiating AAT more than 24 h after blood culture collection was an independent risk factor for mortality, after adjustment for other confounders (OR 7.1, 95% CI 1.3–39.4, P = 0.024).

Conclusions

Candida albicans was the most frequent cause of candidemia at a large tertiary hospital in China, but antifungal resistance is a growing concern among non-albicans Candida species. The mortality rate of patients treated with ineffective antifungal agents based on in vitro susceptibilities was similar to that of patients who received no treatment at all, and delayed initiation of antifungal treatment was associated with increased risk of death.

Keywords

Candida bloodstream infection Candidemia Antifungal therapy Antifungal resistance Risk factors Clinical outcomes 

Abbreviations

AAT

Appropriate antifungal therapy

APACHE

Acute physiology and chronic health evaluation

AT

Antifungal therapy

CBI

Candida bloodstream infection

EMR

Electronic medical record

H

Hours

IAT

Inappropriate antifungal therapy

ICU

Intensive care unit

MIC

Minimal inhibitory concentration(s)

MV

Mechanical ventilation

SOFA

Sequential organ failure assessment

T

Temperature

US

United States

WBC

White blood cell count

WIC

Charlson weighted index of comorbidities

Notes

Funding

This work was supported by the Guangdong Natural Science Foundation (Grants 2014A030313305), Science and Technology Planning Project of Guangzhou, Guangdong Province, P. R. China (Grants 201510010046), Science and Technology Planning Project of Guangdong Province, P. R. China (Grants 2015A050502026) and National Natural Science Foundation of China (Grants 81570012) to Xiaojiang Tan. Dr. Farmakiotis has received research support from Astellas Pharma and consultant fees from Viracor. Dr. Mylonakis has received research support from Astellas Pharma and T2 Biosystems. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All other authors have no financial disclosures.

Compliance with Ethical Standards

Conflict of interest

The authors report no conflict of interest. The authors alone are responsible for the content and the writing of the paper.

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Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Shaoming Lin
    • 1
  • Ruilan Chen
    • 2
    • 3
    • 4
  • Song Zhu
    • 5
  • Huijun Wang
    • 1
  • Lianfang Wang
    • 1
  • Jian Zou
    • 6
  • Jingdong Yan
    • 6
  • Xiangdong Zhang
    • 7
  • Dimitrios Farmakiotis
    • 8
  • Xiaojiang Tan
    • 1
  • Eleftherios Mylonakis
    • 8
  1. 1.Department of Respiratory and Critical Care Medicine, Chronic Airways Disease Laboratory, Huiqiao Medical Center, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople’s Republic of China
  2. 2.Department of Intensive Care UnitFangcun Branch of Guangdong Provincial Hospital of Chinese MedicineGuangzhouPeople’s Republic of China
  3. 3.The Second Clinical College of Guangzhou University of Chinese MedicineGuangzhouPeople’s Republic of China
  4. 4.Guangdong Provincial Academy of Chinese Medical SciencesGuangzhouPeople’s Republic of China
  5. 5.District Five, Fuda Cancer HospitalJinan University School of MedicineGuangzhouPeople’s Republic of China
  6. 6.Informatics Department, Nanfang HospitalSouthern Medical UniversityGuangzhouPeople’s Republic of China
  7. 7.Southern Medical UniversityGuangzhouPeople’s Republic of China
  8. 8.Department of Medicine, Division of Infectious Diseases, Rhode Island HospitalWarren Alpert Medical School of Brown UniversityProvidenceUSA

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