title: Clinical and microbiological investigation of fungemia from four hospitals in China.
abstract: In this study, fungemia cases from four tertiary hospitals located in Shanghai and Anhui province in China from March 2012 to December 2013 were enrolled to investigate clinical features, species distribution, antifungal susceptibility and strain relatedness. During the study period, 137 non-duplicate cases and their corresponding isolates were collected. Six different genera of fungi were identified, of which Candida spp. were the most common (126/137, 91.97 %), with C. albicans predominating (48/137, 35.03 %). The non-Candida fungi rate reached 8.03 % (11/137), and Pichia spp. was the most common (5/137, 3.65 %). Compared with C. albicans, non-C. albicans fungi-associated fungemia was more likely in younger (p = 0.004) and male patients (χ (2) = 6.2618, p = 0.0123) and patients from ICUs (χ (2) = 6.3783, p = 0.0116). Overall, the susceptible/WT rates of common Candida spp. to fluconazole, itraconazole, voriconazole, flucytosine, amphotericin B and caspofungin were 74.63, 92.31, 93.16, 96.58, 100 and 95.69 %, respectively. C. tropicalis and C. guilliermondii had a low susceptibility to fluconazole: 79.95 and 77.78 %, respectively. No isolates were resistant/WT to caspofungin, but C. parapsilosis and C. guilliermondii had high MIC90 values; 1 and 2 mg/L, respectively. In terms of genotyping, MLST was taken for C. glabrata and C. tropicalis, while microsatellite marker analysis was used for C. albicans and C. parapsilosis. C. glabrata was predominantly clone ST7, accounting for 75 %, while the other isolates showed genetic diversity. Considering the increased proportion of non-C. albicans fungi and the presence of endemic clones of C. glabrata, it is essential to undertake additional surveillance of fungemia.
authors.affiliation: Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 197 Ruijin ER Road, Shanghai, 200025, China.
authors.forename: Danfeng
authors.initials: D
authors.lastname: Dong
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.forename: Lihua
authors.initials: L
authors.lastname: Zhang
authors.forename: Cen
authors.initials: C
authors.lastname: Jiang
authors.forename: Enqiang
authors.initials: E
authors.lastname: Mao
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Wang
authors.forename: Yibing
authors.initials: Y
authors.lastname: Peng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology*; D005658:Fungi / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D018895:Microsatellite Repeats; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D016533:Mycological Typing Techniques; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D000935:Antifungal Agents