title: Invasive candidiasis in intensive care units in China: a multicentre prospective observational study.
abstract: OBJECTIVE
  To describe the epidemiology, microbiology and management of invasive Candida infection (ICI) in intensive care units (ICUs) in China.
  
  
  METHODS
  A multicentre, prospective, observational study in 67 hospital ICUs across China. Patients were ≥18 years old with clinical signs of infection and at least one of the following diagnostic criteria: (i) histopathological, cytopathological or microscopic confirmation of yeast cells from a normally sterile site; (ii) at least one peripheral blood culture positive for Candida; and (iii) positive Candida culture from a normally sterile site. The China-SCAN study is registered with ClinicalTrials.gov (NCT T01253954).
  
  
  RESULTS
  ICI incidence was 0.32% (306 patients/96,060 ICU admissions) and median time between ICU admission and diagnosis was 10.0 days. Candida albicans was the most prevalent single isolate (41.8% of patients), although non-albicans species accounted for the majority of infections. Diagnostic confirmation was based solely on at least one positive blood culture in 290 (94.8%) cases. Treatment was initiated after diagnostic confirmation in 166/268 (61.9%) patients. Triazoles (62.7%) and echinocandins (34.2%) were the most commonly used antifungal agents; first-line therapy was typically fluconazole (37.7%). The median duration of antifungal therapy was 14 days. The mortality rate was 36.6% (112/306); the median time between diagnosis and death was 14.5 days. Mortality was higher in older individuals, those with solid tumours, those with recent invasive mechanical ventilation and those with a higher sequential organ failure assessment score at diagnostic confirmation. Susceptibility to first-line antifungals was associated with lower mortality than dose-dependent susceptibility or complete resistance (P=0.008).
  
  
  CONCLUSIONS
  More infections were caused by non-albicans than Candida albicans strains. The majority of patients were treated only after diagnostic confirmation, rather than empirically. First-line antifungal susceptibility was associated with lower mortality.
authors.affiliation: Nanjing Zhongda Hospital, Southeast University School of Medicine, Nanjing, China.
authors.forename: Fengmei
authors.initials: F
authors.lastname: Guo
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Yan
authors.initials: Y
authors.lastname: Kang
authors.forename: Bin
authors.initials: B
authors.lastname: Zang
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
authors.forename: Bingyu
authors.initials: B
authors.lastname: Qin
authors.forename: Yingzhi
authors.initials: Y
authors.lastname: Qin
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fang
authors.forename: Tiehe
authors.initials: T
authors.lastname: Qin
authors.forename: Dongpo
authors.initials: D
authors.lastname: Jiang
authors.forename: Weiqin
authors.initials: W
authors.lastname: Li
authors.forename: Qin
authors.initials: Q
authors.lastname: Gu
authors.forename: Hongsheng
authors.initials: H
authors.lastname: Zhao
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Guan
authors.forename: Jianguo
authors.initials: J
authors.lastname: Li
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Ma
authors.forename: Kaijiang
authors.initials: K
authors.lastname: Yu
authors.forename: Dechang
authors.initials: D
authors.lastname: Chan
authors.forename: Jing
authors.initials: J
authors.lastname: Yan
authors.forename: Yaoqing
authors.initials: Y
authors.lastname: Tang
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Ruoyu
authors.initials: R
authors.lastname: Li
authors.forename: Haibo
authors.initials: H
authors.lastname: Qiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000382:microbiology; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Candida albicans; ICUs; antifungal; invasive Candida infection