Epidemiological Characteristics, Antifungal Susceptibility, Risk Factors, and Outcomes of Candida Bloodstream Infection: A Ten-Year Surveillance in a Teaching Hospital in China
Yan Qiao, Zhaoyu Tao, Feiran Hao, Yongqiang Huang, Hong Sun, Pu Guo
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