A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpatients in a tertiary teaching hospital in China

Abstract

Background: There are no current national estimates of the candidaemia burden in China, and epidemiological candidaemia data from the underdeveloped region of China are lacking. Methods: A 7-year retrospective study was carried out to analyse the prevalence, species distribution, antifungal susceptibility, risk factors and inpatient mortality of candidaemia among paediatric and adult patients in a regional tertiary teaching hospital in China. Results: During the seven-year study period, a total of 201 inpatients with candidaemia were identified. The median age of the patients was 65 years (range, 1 day to 92 years), and 114 of the patients (56.7%) were male. The mean annual incidence of candidaemia was 0.26 cases per 1000 admissions (0.42 cases per 1000 paediatric admissions vs 0.24 cases per 1000 adult admissions, P < 0.05). Candida albicans was the most common fungal species (81/201, 40.3%) in all patients, Candida glabrata was the most common fungal species (18/35, 51.4%) in paediatric patients. Most isolates were susceptible to flucytosine (99.0%) and amphotericin B (99.0%), and the activity of antifungal agents against Candida species was no significant difference in satisfaction between paediatric and adult patients (P > 0.05). The all-cause mortality rate was 20.4% (paediatric patients: 11.4% vs adult patients: 22.3%, P > 0.05). Fewer univariate predictors of poor outcomes were identified for paediatric patients than for adult patients (4 vs 11 predictors). Respiratory dysfunction and septic shock were independent predictors of 30-day mortality for all patients. Conclusions: The epidemiological data of candidaemia in paediatric and adult patients are only different in the distributions of Candida species and the mean annual incidence of candidaemia. Flucytosine and amphotericin B can be used as first-choice agents when no antifungal susceptibility test results are available.

Epidemiology of Candidemia in Kuwait: A Nationwide, Population-Based Study

“…Similarly, studies from the USA have also reported higher incidence values, with a total of ≥7 cases per 100,000 inhabitants [ 23 , 24 , 54 , 57 ]. Epidemiological studies from China (26 cases per 100,000 hospital admissions compared to 90 cases per 100,000 patients in the USA) have also reported incidence values which are comparable to the data from Kuwait and European countries [ 23 , 24 , 58 , 59 , 60 ]. One study from Thailand, however, reported a higher incidence rate of 13.3 per 100,000 individuals [ 61 ].…”

Molecular characterisation of Candida auris isolates from immunocompromised patients in a tertiary‐care hospital in Kuwait reveals a novel mutation in FKS1 conferring reduced susceptibility to echinocandins

“…infections are associated with considerable all-cause mortality that varies from nearly 20% to more than 60% in different patient populations from various geographic regions/countries and is higher among patients in the ICU. 4,5,10,11,[17][18][19] Epidemiological studies carried out in the last two decades showed that more than 90% of Candida spp. infections are caused by only five species/species-complexes which include C albicans, C tropicalis, C parapsilosis, C glabrata and C krusei.…”

“…causing invasive infections at some geographical locations/healthcare facilities. 18,[23][24][25] Furthermore, infections caused by uncommon or emerging Candida spp. as well as infections with drugresistant strains have increased considerably in select patient populations in recent years.…”

Multilocus Sequence Typing and Antifungal Susceptibility of Vaginal and Non-vaginal Candida glabrata Isolates From China

“…Numerous studies have shown reduced susceptibility to fluconazole or voriconazole among C. glabrata isolates ( Song et al, 2020 ; Zeng et al, 2020 , 2021 ), such as the large survey of Candida isolates from the Asia-Pacific region ( Tan et al, 2016 ). A study examining 77 hospitals in China (across seven administrative regions) over a period of 3 years has shown an overall fluconazole resistance rate of 10.2% (3.1–11.4%) and a decrease in voriconazole susceptibility in C. glabrata ( Xiao et al, 2020 ).…”