title: Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai.
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.
  
  
  CONCLUSIONS
  The epidemiology of candidemia in Shanghai differed from that observed in Western countries. Appropriate empiric antifungal therapy influenced the short-term survival.
authors.forename: Zhi-Tao
authors.initials: ZT
authors.lastname: Yang
authors.forename: Lin
authors.initials: L
authors.lastname: Wu
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Liu
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Wu
authors.forename: Yong
authors.initials: Y
authors.lastname: Cai
authors.forename: En-Qiang
authors.initials: EQ
authors.lastname: Mao
authors.affiliation: Emergency Department & Emergency Intensive Care Unit, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, No, 197 Ruijin Er Road, Shanghai 200025, China. chenerzhen@hotmail.com.
authors.forename: Er-Zhen
authors.initials: EZ
authors.lastname: Chen
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida; D002176:Candida albicans / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D005260:Female; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents