title: Nosocomial Bloodstream Infection Due to Candida spp. in China: Species Distribution, Clinical Features, and Outcomes.
abstract: OBJECTIVE
  To investigate the distribution of Candida spp., predictors of mortality, and effects of therapeutic measures on outcomes of nosocomial bloodstream infection (BSI) due to Candida spp.
  
  
  METHODS
  This retrospective, population-based study enrolled adult patients with Candida nosocomial BSI from January 2010 to December 2014 in one tertiary care hospital. The demographics, comorbidities, species distribution, risk factors, and effects of antifungal treatment were assessed.
  
  
  RESULTS
  In total, 190 episodes of Candida BSI were identified. The most prevalent species was C. albicans (38.9 %), followed by C. parapsilosis (23.2 %) and C. tropicalis (20.5 %). In vitro susceptibility testing showed that 88.9 % of Candida isolates were susceptible to fluconazole. The 30-day hospital mortality was 27.9 %, while the early mortality (within 7 days) was 16.3 %. In a multivariate regression analysis, the Acute Physiology and Chronic Health Evaluation II score [odds ratio (OR) 1.23; 95 % confidence interval (CI) 1.080-1.390; P = 0.002] and severe sepsis or septic shock (OR 15.35; 95 % CI 2.391-98.502; P = 0.004) were independently correlated with early mortality. Severe sepsis or septic shock (OR 24.75; 95 % CI 5.099-120.162; P < 0.001) was an independent risk factor for 30-day mortality, while proven catheter-related candidemia (OR 0.16; 95 % CI 0.031-0.810; P = 0.027) was a positive factor for 30-day mortality. Early central venous catheter removal and adequate antifungal treatment were closely related to decreased mortality in patients with primary candidemia.
  
  
  CONCLUSIONS
  The proportion of candidemia caused by C. albicans was lower than that caused by non-albicans species. The severity of illness influenced early mortality, and the origin of the central venous catheter remarkably affected 30-day mortality.
authors.affiliation: Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, 100853, China.
authors.forename: Mingmei
authors.initials: M
authors.lastname: Du
authors.affiliation: Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853, China.
authors.forename: Liang-An
authors.initials: LA
authors.lastname: Chen
authors.affiliation: Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, 100853, China.
authors.forename: Yunxi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, Chinese PLA General Hospital, Fuxing Road No. 28, Beijing, 100853, China. liangzhixin301@163.com.
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Candida species; Mortality; Nosocomial candidemia; Treatment outcome