Epidemiological Characteristics, Antifungal Susceptibility, Risk Factors, and Outcomes of Candida Bloodstream Infection: A Ten-Year Surveillance in a Teaching Hospital in China

Abstract

Background

Candida is one of the most important pathogens of hospital-acquired bloodstream infections. Its morbidity and mortality are still high, which is a serious global public problem.

Purpose

To investigate the strain distribution, drug susceptibility, clinical characteristics of patients, and risk factors affecting the prognosis of Candida bloodstream infection (BSI).

Materials and Methods

We retrospectively collected the clinical data, infection-related indicators, prognosis, strain prevalence and drug susceptibility of 163 patients with Candida BSI in a teaching hospital from January 2012 to December 2022. Univariate and multivariate logistic regression were used to analyze the risk factors affecting the prognosis.

Results

In 163 cases of Candida BSI, Candida albicans accounted for 48.47%, and Candida non-albicans accounted for 51.53%. A total of 163 patients with Candida BSI were mainly distributed in intensive care unit (ICU) and emergency department, accounting for 40.49% and 14.72%, respectively. The resistance rate of Candida albicans to fluconazole, itraconazole and voriconazole was less than 10%, and the sensitivity rate of Candida tropicalis to fluconazole, itraconazole and voriconazole was less than 80%. The mortality rate of 163 patients with Candida BSI was 33.13%, with Candida non-albicans higher than that of Candida albicans (p = 0.04). Multivariate analysis showed that hemodialysis (OR = 0.199, 95% CI: 0.059–0.673, P = 0.009), arteriovenous catheters (OR = 0.344, 95% CI: 0.130–0.913, P = 0.032), elevated neutrophil count (OR = 0.409, 95% CI: 0.194–0.862, P = 0.019) and APACHE II score (OR = 0.848, 95% CI: 0.789~0.911, P < 0.001) were independent risk factors for death in patients with candidemia.

Conclusion

The blood flow infection rate of Candida non-albicans is increasing, and the mortality rate and resistance to antifungal drugs are higher than that of Candida albicans. Hemodialysis, arteriovenous catheters, elevated neutrophil count and APACHE II score were associated with death in patients with Candida BSI.

Keywords:

• Candida
• bloodstream infection
• clinical features
• prognosis

Ethical Approval

In this study, strains isolated from patient samples were used for research without adverse reactions and risks to the subjects, and the research data should be kept confidential for the information of the subjects, including cases and biological samples. The study was approved by the Medical Ethics Committee of the First Affiliated Hospital of Bengbu Medical College. This study was conducted in accordance with the Declaration of Helsinki.

Acknowledgment

This work is supported by the Natural Science Research Project of Universities in Anhui Province (KJ2021A0761).

Disclosure

The authors declare that there is no conflict of interest in this work.