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Open Access Research article

Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai

Zhi-Tao Yang12, Lin Wu3, Xiao-Ying Liu1, Min Zhou4, Jie Li4, Jia-Yin Wu5, Yong Cai6, En-Qiang Mao1, Er-Zhen Chen1* and Olivier Lortholary78*

Author Affiliations

1 Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China

2 Pôle Sino-Français de Recherches en Science du Vivant et Génomique, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China

3 Geriatric Department, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China

4 Clinical Microbiology Department, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025 China

5 Informatics Department, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, No. 197 Ruijin Er Road, Shanghai 200025, China

6 Public Health Institute, Shanghai Jiaotong University, School of Medicine, No. 227 Chongqing Nan Road, Shanghai 200025, China

7 Université Paris Descartes, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants malades, Centre d’Infectiologie Necker Pasteur, IHU Imagine, 149, rue de Sèvres, 75743 Paris Cedex 15, France

8 Institut Pasteur, Centre National de Référence Mycologie et Antifongiques, CNRS URA3012, Paris France

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BMC Infectious Diseases 2014, 14:241  doi:10.1186/1471-2334-14-241

Published: 6 May 2014

Abstract

Background

Yeasts, mostly Candida, are important causes of bloodstream infections (BSI), responsible for significant mortality and morbidity among hospitalized patients. The epidemiology and species distribution vary from different regions. The goals of this study were to report the current epidemiology of Candida BSI in a Shanghai Teaching Hospital and estimate the impact of appropriate antifungal therapy on the outcome.

Methods

From January 2008 to December 2012, all consecutive patients who developed Candida BSI at Ruijin University Hospital were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy and its impact on the outcome were analyzed.

Results

A total of 121 episodes of Candida BSI were identified, with an incidence of 0.32 episodes/1,000 admissions (0.21 in 2008 and 0.42 in 2012) The proportion of candidemia caused by non-albicans species (62.8%), including C. parapsilosis (19.8%), C. tropicalis (14.9%), C. glabrata (7.4%), C. guilliermondii (5.8%), C. sake (5.0%) was higher than that of candidemia caused by C. albicans (37.2%). The overall crude 28-day mortality was 28.1% and significantly reduced with appropriate empiric antifungal therapy administered within 5 days (P = 0.006). Advanced age (OR 1.04; P = 0.014), neutropenia < 500/mm3 (OR 17.44; P < 0.001) were independent risk factors for 28-day mortality, while appropriate empiric antifungal therapy (OR 0.369; P = 0.035) was protective against 28-day mortality.

Conclusion

The epidemiology of candidemia in Shanghai differed from that observed in Western countries. Appropriate empiric antifungal therapy influenced the short-term survival.

Keywords:
Candida spp; Bloodstream infection; Appropriate antifungal therapy; Survival