A Ten-Year Retrospective Study of Invasive Candidiasis in a Tertiary Hospital

Abstract

Background: Invasive candidiasis (IC) is a leading cause of mycosis-associated mortality worldwide. Delay in diagnosis and antifungal therapy significantly increases the risk of death. Thus, comprehensive knowledge of IC is required to recognize the IC onset timely. Objectives: This study aimed to evaluate the epidemiological, clinical and mycological characteristics of IC in China.Methods: A ten-year retrospective study including 183 IC episodes was conducted in a tertiary hospital in Beijing, China.Results: The overall incidence rate during 2010-2019 was 0.261 episodes per 1,000 discharges. Candidemia (71.0%) was the major infective pattern. 70.3% of the patients tested positive for Candida spp. colonization before IC and the median time to develop an invasive infection after colonization was 13.5 days (interquartile range: 4.5-37.0 days). Candida albicans (45.8%) was the most prevalent species, followed by Candida parapsilosis (19.5%), Candida glabrata (14.2%) and Candida tropicalis (13.7%). C. non-albicans IC was more common in patients with severe anemia (p=0.018), long-term hospitalization (p=0.015), hematologic malignancies (p=0.002), continuous administration of broad-spectrum antibiotics (p<0.001) and mechanical ventilation (p=0.012). In vitro resistance testing showed that 14.4% of the Candida isolates were resistant/ non-wild type (non-WT) to fluconazole, followed by voriconazole (9.6%), micafungin (3.8%) and caspofungin (2.9%). Fluconazole was the most commonly used drug to initiate antifungal therapy both before and after the proven diagnosis (52.6% and 54.6%, respectively). 30-day and 90-day all-cause mortality was 24.5% and 32.7%, respectively. Conclusions: The incidence of IC was lower in recent years. C. non-albicans contributed to more than half of the IC cases. Fluconazole could still be used as first-line therapy if its resistance/ non-WT was not prevalent. The mortality of IC was still high. A prospective, multi-center surveillance to clinical and mycological characteristics of IC is required.

Correlation Between Drug Resistance and Virulence of Candida Isolates from Patients with Candidiasis

“… 32 In a ten-year retrospective study conducted in a tertiary hospital, patients aged over 65 accounted for more than half of a total of 183 invasive candidiasis (IC) episodes (54.1%, 99/183). 6 Our data show a similar age effect for IC, even though our sample is smaller. Several explanations are possible here.…”

“…3 Today, the global prevalence of candidemia is 6.9/1000 persons 4 and approximately 250,000 new cases of IC are reported per year, of which more than 50,000 result in death, although others have reported a mortality rate of up to 60%. [5][6][7] There are more than 15 species of Candida spp. identified as human pathogens.…”

Distribution and antifungal susceptibility pattern ofCandidaspecies from mainland China: A systematic analysis

“… 13 (14.61%) NA Phenotypic identification methods CHROMagar media 41 (46.06%) ( 26 , 37 , 42 , 44 , 47 , 50 , 55 , 56 , 59 , 67-70 , 72 , 75-83 , 85-88 , 91 , 95 , 96 , 98 , 99 , 101-103 , 105 , 106 , 109 , 111 , 112 , 123 ) MALDI-TOF MS 29 (32.58%) (5, 16 , 24 , 38 , 40 , 43 , 47 , 48 , 50 , 57 , 59 , 67 , 68 , 80 , 94 , 97 , 99 , 102 , 108 , 110 , 111 , 113 , 114 , 116 , 120 , ...…”

“…Besides this, the co-morbidities like hypoproteinemia, cardiovascular disease, diabetes, respiratory dysfunction, renal failure, cancer, HIV, and thrombocytopenia are reported to be significant for candidiasis development [ 21 , 27 , 29 , 30 , 32 , 33 , 94 ]. Apart from this, catheterization, mechanical ventilation, elderly patients, empirical antifungal therapy, and surgeries are secondary risk factors [ 21 , 26 , 27 , 29–37 , 94 , 101 ]. The risk factors reported in the present study are comparable to the findings of other studies [ 105 , 61 , 121 , 122 ].…”

Assessment of Fungal Blood Stream Infection in Patients with Liver Cirrhosis Admitted to The Intensive Care Unit

“…Since β-DG's sensitivity and specificity depend on the cut-off value of kits used for diagnosis, the results are not accurate and not sure for the existence of IFI. As a result, misdiagnosis and inadequate care with antifungal medicines are common, both of which contribute to the spread of resistance (23) . Host variables, clinical symptoms, mycological evidence, and indirect tests (β-DG and mannan/antimannan) were all part of the EORTC/definition MSG's of probable IFI.…”