Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 May 6:14:241.
doi: 10.1186/1471-2334-14-241.

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

Zhi-Tao Yang, Lin Wu, Xiao-Ying Liu, Min Zhou, Jie Li, Jia-Yin Wu, Yong Cai, En-Qiang Mao, Er-Zhen Chen  1 , Olivier Lortholary
Affiliations

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

Zhi-Tao Yang et al. BMC Infect Dis. .

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Distribution of the Candida species by origin [ C. albicans vs. C. non- albicans (p = 0.074)].
Figure 2
Figure 2
Relationship between hospital mortality (28-day) and the timing of antifungal treatment. The timing of antifungal therapy was determined to be from the time when the first blood sample for culture that was positive for fungi was drawn to the time when appropriate antifungal treatment was first administered to the patient. 28-day mortality was significantly lower for those who received appropriate empiric antifungal therapy within 120 h (5d) vs. inappropriate or delayed (>5d) empiric antifungal therapy or no antifungal treatment (20.9% vs. 45.7%, p = 0.006).
Figure 3
Figure 3
Kaplan–Meier survival curves (28-day) based on the initiation of empiric appropriate antifungal therapy [Log Rank (mantel-Cox) chi-square =12.784, p < 0.001].
See this image and copyright information in PMC

References

    1. Marchetti O, Bille J, Fluckiger U, Eggimann P, Ruef C, Garbino J, Calandra T, Glauser MP, Tauber MG, Pittet D. Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991–2000. Clin Infect Dis. 2004;14(3):311–320. doi: 10.1086/380637. - DOI - PubMed
    1. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;14(3):309–317. doi: 10.1086/421946. - DOI - PubMed
    1. Bassetti M, Taramasso L, Nicco E, Molinari MP, Mussap M, Viscoli C. Epidemiology, species distribution, antifungal susceptibility and outcome of nosocomial candidemia in a tertiary care hospital in Italy. PLoS One. 2011;14(9):e24198. doi: 10.1371/journal.pone.0024198. - DOI - PMC - PubMed
    1. Zhang XB, Yu SJ, Yu JX, Gong YL, Feng W, Sun FJ. Retrospective analysis of epidemiology and prognostic factors for candidemia at a hospital in China, 2000–2009. Jpn J Infect Dis. 2012;14(6):510–515. doi: 10.7883/yoken.65.510. - DOI - PubMed
    1. Chen PY, Chuang YC, Wang JT, Sheng WH, Yu CJ, Chu CC, Hsueh PR, Chang SC, Chen YC. Comparison of epidemiology and treatment outcome of patients with candidemia at a teaching hospital in Northern Taiwan, in 2002 and 2010. J Microbiol Immunol Infect. 2014;14(2):95–103. doi: 10.1016/j.jmii.2012.08.025. - DOI - PubMed

Publication types

MeSH terms

Substances