Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

Abstract

Background: Candidemia is an important cause of mortality in healthcare settings. Peripheral lines are a source of candidemia, yet few studies have reported on the clinico-epidemiological features of candidemia due to peripheral-line associated blood stream infection (PLABSI).

Methods: We conducted a single-centre retrospective cohort study of all patients with candidemia between 2002 and 2013. PLABSI was defined as the presence of at least one of the following: the presence of phlebitis or the resolution of clinical symptoms after peripheral-line withdrawal, with careful exclusion of an alternative explanation for bacteraemia. We described the epidemiology of candidemia and assessed predictive factors of PLABSI due to Candida spp., peripheral line-associated candidemia (PLAC), compared with non-PLAC.

Results: A total of 301 episodes of candidemia, including 37 of PLAC, were diagnosed during the study period. Central-line associated blood stream infection, intra-abdominal infection, and infection of unknown source accounted for the remaining 233, 14, and 17 cases, respectively. The overall incidence rate of candidemia was 0.11/1000 patient-days. In multivariate analysis, cephalosporin exposure (odds ratio [OR] = 2.22, 95% CI 1.04-4.77), polymicrobial bacteraemia/fungaemia (OR = 2.87, 95% CI 1.02-8.10), and ID specialist consultation (OR = 2.40, 95% CI 1.13-5.13) were identified as independent predictors of PLAC. Although non-PLAC had a higher mortality, the length of hospital stay after candidemia was similar between the two groups and candidemia duration was longer in the PLAC group.

Conclusion: PLACs are an important cause of candidemia in hospitalized patients. Appropriate identification and management of PLAC are crucial.

Fig 1. Number of episodes and distribution of source for candidemia, 2002–2013 (n = 301).

The number of episodes of candidemia is indicated by solid lines. Bars express proportion of source for candidemia: black indicates PLABSI; white, CLABSI; grey, intra-abdominal infection; and dotted, unknown source.

Fig 2. Distribution of isolated of Candida spp., 2002–2013 (n = 316).

* * Includes 15 episodes of polymicrobial bacteraemia/fungaemia Bars express proportion of Candida spp.: black indicates C. albicans; white, C. glabrata; shaded, C. parapsilosis; dotted, C. tropicalis; and grey, others.