Skip to main content
Top
Published in: Antimicrobial Resistance & Infection Control 1/2020

01-12-2020 | Amphotericin B | Research

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

Authors: Zhangrui Zeng, Yinhuan Ding, Gang Tian, Kui Yang, Jian Deng, Guangrong Li, Jinbo Liu

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2020

Login to get access

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.
Literature
1.
go back to reference Kullberg BJ, Arendrup MC. Invasive Candidiasis. N Engl J Med. 2015;373(15):1445–56.PubMed Kullberg BJ, Arendrup MC. Invasive Candidiasis. N Engl J Med. 2015;373(15):1445–56.PubMed
2.
go back to reference Antinori S, Milazzo L, Sollima S, et al. Candidemia and invasive candidiasis in adults: a narrative review. Eur J Intern Med. 2016;34:21–8.PubMed Antinori S, Milazzo L, Sollima S, et al. Candidemia and invasive candidiasis in adults: a narrative review. Eur J Intern Med. 2016;34:21–8.PubMed
4.
go back to reference Ala-Houhala M, Valkonen M, Kolho E, et al. Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007–2016. Infect Dis (Lond). 2019;51(11–12):824–30. Ala-Houhala M, Valkonen M, Kolho E, et al. Clinical and microbiological factors associated with mortality in candidemia in adult patients 2007–2016. Infect Dis (Lond). 2019;51(11–12):824–30.
5.
go back to reference Kato H, Yoshimura Y, Suido Y, et al. Mortality and risk factor analysis for Candida blood stream infection: a multicenter study. J Infect Chemother. 2019;25(5):341–5.PubMed Kato H, Yoshimura Y, Suido Y, et al. Mortality and risk factor analysis for Candida blood stream infection: a multicenter study. J Infect Chemother. 2019;25(5):341–5.PubMed
6.
go back to reference Ghazi S, Rafei R, Osman M, et al. The epidemiology of Candida species in the Middle East and North Africa. J Mycol Med. 2019;29(3):245–52.PubMed Ghazi S, Rafei R, Osman M, et al. The epidemiology of Candida species in the Middle East and North Africa. J Mycol Med. 2019;29(3):245–52.PubMed
7.
go back to reference Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis. 2010;14(11):e954–66.PubMed Falagas ME, Roussos N, Vardakas KZ. Relative frequency of albicans and the various non-albicans Candida spp among candidemia isolates from inpatients in various parts of the world: a systematic review. Int J Infect Dis. 2010;14(11):e954–66.PubMed
8.
go back to reference Lausch KR, Sogaard M, Rosenvinge FS, et al. High incidence of candidaemia in a nationwide cohort: underlying diseases, risk factors and mortality. Int J Infect Dis. 2018;76:58–63.PubMed Lausch KR, Sogaard M, Rosenvinge FS, et al. High incidence of candidaemia in a nationwide cohort: underlying diseases, risk factors and mortality. Int J Infect Dis. 2018;76:58–63.PubMed
9.
go back to reference McCarty TP, Pappas PG. Invasive Candidiasis. Infect Dis Clin North Am. 2016;30(1):103–24.PubMed McCarty TP, Pappas PG. Invasive Candidiasis. Infect Dis Clin North Am. 2016;30(1):103–24.PubMed
10.
go back to reference Strollo S, Lionakis MS, Adjemian J, et al. Epidemiology of hospitalizations associated with invasive candidiasis, United States, 2002-2012. Emerg Infect Dis. 2016;23(1):7–13.PubMed Strollo S, Lionakis MS, Adjemian J, et al. Epidemiology of hospitalizations associated with invasive candidiasis, United States, 2002-2012. Emerg Infect Dis. 2016;23(1):7–13.PubMed
11.
go back to reference Chen M, Xu Y, Hong N, et al. Epidemiology of fungal infections in China. Front Med. 2018;12(1):58–75.PubMed Chen M, Xu Y, Hong N, et al. Epidemiology of fungal infections in China. Front Med. 2018;12(1):58–75.PubMed
12.
go back to reference Zhang Y, Wang F, Expert Group of the Summit Forum on diagnosis and treatment Strategy of Candidiasis CMA. The diagnosis and treatment of Candidiasis:the expert consensus. Chin J Infect Chemother(Chin). 2011;11(2):81–95 (http://www.cjic.com.cn/mulu112.htm). Zhang Y, Wang F, Expert Group of the Summit Forum on diagnosis and treatment Strategy of Candidiasis CMA. The diagnosis and treatment of Candidiasis:the expert consensus. Chin J Infect Chemother(Chin). 2011;11(2):81–95 (http://​www.​cjic.​com.​cn/​mulu112.​htm).
13.
go back to reference Cuenca-Estrella M, Verweij PE, Arendrup MC, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures. Clin Microbiol Infect. 2012;18(Suppl 7):9–18.PubMed Cuenca-Estrella M, Verweij PE, Arendrup MC, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures. Clin Microbiol Infect. 2012;18(Suppl 7):9–18.PubMed
14.
go back to reference Ullmann AJ, Cornely OA, Donnelly JP, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases. Clin Microbiol Infect. 2012;18(Suppl 7):1–8.PubMed Ullmann AJ, Cornely OA, Donnelly JP, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: developing European guidelines in clinical microbiology and infectious diseases. Clin Microbiol Infect. 2012;18(Suppl 7):1–8.PubMed
15.
go back to reference Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the Management of Candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1–50.PubMed Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the Management of Candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1–50.PubMed
16.
go back to reference Braga PR, Cruz IL, Ortiz I, et al. Secular trends of candidemia at a Brazilian tertiary care teaching hospital. Braz J Infect Dis. 2018;22(4):273–7.PubMed Braga PR, Cruz IL, Ortiz I, et al. Secular trends of candidemia at a Brazilian tertiary care teaching hospital. Braz J Infect Dis. 2018;22(4):273–7.PubMed
17.
go back to reference Santolaya ME, Thompson L, Benadof D, et al. A prospective, multi-center study of Candida bloodstream infections in Chile. PLoS One. 2019;14(3):e0212924.PubMedPubMedCentral Santolaya ME, Thompson L, Benadof D, et al. A prospective, multi-center study of Candida bloodstream infections in Chile. PLoS One. 2019;14(3):e0212924.PubMedPubMedCentral
18.
go back to reference Jia X, Li C, Cao J, et al. Clinical characteristics and predictors of mortality in patients with candidemia: a six-year retrospective study. Eur J Clin Microbiol Infect Dis. 2018;37(9):1717–24.PubMed Jia X, Li C, Cao J, et al. Clinical characteristics and predictors of mortality in patients with candidemia: a six-year retrospective study. Eur J Clin Microbiol Infect Dis. 2018;37(9):1717–24.PubMed
19.
go back to reference Lin S, Chen R, Zhu S, et al. Candidemia in adults at a tertiary Hospital in China: clinical characteristics, species distribution, resistance, and outcomes. Mycopathologia. 2018;183(4):679–89.PubMed Lin S, Chen R, Zhu S, et al. Candidemia in adults at a tertiary Hospital in China: clinical characteristics, species distribution, resistance, and outcomes. Mycopathologia. 2018;183(4):679–89.PubMed
20.
go back to reference Hesstvedt L, Gaustad P, Muller F, et al. The impact of age on risk assessment, therapeutic practice and outcome in candidemia. Infect Dis (Lond). 2019;51(6):425–34. Hesstvedt L, Gaustad P, Muller F, et al. The impact of age on risk assessment, therapeutic practice and outcome in candidemia. Infect Dis (Lond). 2019;51(6):425–34.
21.
go back to reference Keighley C, Chen SC, Marriott D, et al. Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study. BMC Infect Dis. 2019;19(1):445.PubMedPubMedCentral Keighley C, Chen SC, Marriott D, et al. Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study. BMC Infect Dis. 2019;19(1):445.PubMedPubMedCentral
22.
go back to reference Lindberg E, Hammarstrom H, Ataollahy N, et al. Species distribution and antifungal drug susceptibilities of yeasts isolated from the blood samples of patients with candidemia. Sci Rep. 2019;9(1):3838.PubMedPubMedCentral Lindberg E, Hammarstrom H, Ataollahy N, et al. Species distribution and antifungal drug susceptibilities of yeasts isolated from the blood samples of patients with candidemia. Sci Rep. 2019;9(1):3838.PubMedPubMedCentral
23.
go back to reference Ortega-Loubon C, Cano-Hernandez B, Poves-Alvarez R, et al. The overlooked immune state in Candidemia: a risk factor for mortality. J Clin Med. 2019;8(10):1512.PubMedCentral Ortega-Loubon C, Cano-Hernandez B, Poves-Alvarez R, et al. The overlooked immune state in Candidemia: a risk factor for mortality. J Clin Med. 2019;8(10):1512.PubMedCentral
24.
go back to reference Alkharashi N, Aljohani S, Layqah L, et al. Candida bloodstream infection: changing pattern of occurrence and antifungal susceptibility over 10 years in a tertiary care Saudi hospital. Can J Infect Dis Med Microbiol. 2019;2019:2015692.PubMedPubMedCentral Alkharashi N, Aljohani S, Layqah L, et al. Candida bloodstream infection: changing pattern of occurrence and antifungal susceptibility over 10 years in a tertiary care Saudi hospital. Can J Infect Dis Med Microbiol. 2019;2019:2015692.PubMedPubMedCentral
25.
go back to reference Medeiros MAP, Melo APV, Bento AO, et al. Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: a six-year retrospective study. PLoS One. 2019;14(8):e0221033.PubMedPubMedCentral Medeiros MAP, Melo APV, Bento AO, et al. Epidemiology and prognostic factors of nosocomial candidemia in Northeast Brazil: a six-year retrospective study. PLoS One. 2019;14(8):e0221033.PubMedPubMedCentral
26.
go back to reference Orsetti E, Brescini L, Mazzanti S, et al. Characterisation of candidemia in patients with recent surgery: a 7-year experience. Mycoses. 2019;62(11):1056–63.PubMed Orsetti E, Brescini L, Mazzanti S, et al. Characterisation of candidemia in patients with recent surgery: a 7-year experience. Mycoses. 2019;62(11):1056–63.PubMed
27.
go back to reference Pinto-Magalhaes S, Martins A, Lacerda S, et al. Candidemia in a Portuguese tertiary care hospital: analysis of a 2-year period. J Mycol Med. 2019;29(4):320–4.PubMed Pinto-Magalhaes S, Martins A, Lacerda S, et al. Candidemia in a Portuguese tertiary care hospital: analysis of a 2-year period. J Mycol Med. 2019;29(4):320–4.PubMed
28.
go back to reference Luzzati R, Merelli M, Ansaldi F, et al. Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study. Infection. 2016;44(6):747–55.PubMed Luzzati R, Merelli M, Ansaldi F, et al. Nosocomial candidemia in patients admitted to medicine wards compared to other wards: a multicentre study. Infection. 2016;44(6):747–55.PubMed
29.
go back to reference Canela HMS, Cardoso B, Vitali LH, et al. Prevalence, virulence factors and antifungal susceptibility of Candida spp. isolated from bloodstream infections in a tertiary care hospital in Brazil. Mycoses. 2018;61(1):11–21.PubMed Canela HMS, Cardoso B, Vitali LH, et al. Prevalence, virulence factors and antifungal susceptibility of Candida spp. isolated from bloodstream infections in a tertiary care hospital in Brazil. Mycoses. 2018;61(1):11–21.PubMed
30.
go back to reference Papadimitriou-Olivgeris M, Spiliopoulou A, Kolonitsiou F, et al. Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009-2017) in a university Greek hospital. Infection. 2019;47(2):209–16.PubMed Papadimitriou-Olivgeris M, Spiliopoulou A, Kolonitsiou F, et al. Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009-2017) in a university Greek hospital. Infection. 2019;47(2):209–16.PubMed
31.
go back to reference Siopi M, Tarpatzi A, Kalogeropoulou E, et al. Epidemiological trends of Fungemia in Greece with a focus on Candidemia during the recent financial crisis: a 10-year survey in a tertiary care academic hospital and review of literature. Antimicrob Agents Chemother. 2020;64(3):e01516–9. https://doi.org/10.1128/AAC.01516-19.CrossRefPubMed Siopi M, Tarpatzi A, Kalogeropoulou E, et al. Epidemiological trends of Fungemia in Greece with a focus on Candidemia during the recent financial crisis: a 10-year survey in a tertiary care academic hospital and review of literature. Antimicrob Agents Chemother. 2020;64(3):e01516–9. https://​doi.​org/​10.​1128/​AAC.​01516-19.CrossRefPubMed
32.
go back to reference Israel S, Amit S, Israel A, et al. The epidemiology and susceptibility of Candidemia in Jerusalem. Israel Front Cell Infect Microbiol. 2019;9:352.PubMed Israel S, Amit S, Israel A, et al. The epidemiology and susceptibility of Candidemia in Jerusalem. Israel Front Cell Infect Microbiol. 2019;9:352.PubMed
33.
go back to reference Koehler P, Stecher M, Cornely OA, et al. Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect. 2019;25(10):1200–12.PubMed Koehler P, Stecher M, Cornely OA, et al. Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect. 2019;25(10):1200–12.PubMed
34.
go back to reference Ryan P, Motherway C, Powell J, et al. Candidaemia in an Irish intensive care unit setting between 2004 and 2018 reflects increased incidence of Candida glabrata. J Hosp Infect. 2019;102(3):347–50.PubMed Ryan P, Motherway C, Powell J, et al. Candidaemia in an Irish intensive care unit setting between 2004 and 2018 reflects increased incidence of Candida glabrata. J Hosp Infect. 2019;102(3):347–50.PubMed
35.
go back to reference Li Y, Du M, Chen LA, et al. Nosocomial bloodstream infection due to Candida spp. in China: species distribution, clinical features, and outcomes. Mycopathologia. 2016;181(7–8):485–95.PubMed Li Y, Du M, Chen LA, et al. Nosocomial bloodstream infection due to Candida spp. in China: species distribution, clinical features, and outcomes. Mycopathologia. 2016;181(7–8):485–95.PubMed
36.
go back to reference Xiao Z, Wang Q, Zhu F, et al. Epidemiology, species distribution, antifungal susceptibility and mortality risk factors of candidemia among critically ill patients: a retrospective study from 2011 to 2017 in a teaching hospital in China. Antimicrob Resist Infect Control. 2019;8:89.PubMedPubMedCentral Xiao Z, Wang Q, Zhu F, et al. Epidemiology, species distribution, antifungal susceptibility and mortality risk factors of candidemia among critically ill patients: a retrospective study from 2011 to 2017 in a teaching hospital in China. Antimicrob Resist Infect Control. 2019;8:89.PubMedPubMedCentral
37.
go back to reference Ma CF, Li FQ, Shi LN, et al. Surveillance study of species distribution, antifungal susceptibility and mortality of nosocomial candidemia in a tertiary care hospital in China. BMC Infect Dis. 2013;13:337.PubMedPubMedCentral Ma CF, Li FQ, Shi LN, et al. Surveillance study of species distribution, antifungal susceptibility and mortality of nosocomial candidemia in a tertiary care hospital in China. BMC Infect Dis. 2013;13:337.PubMedPubMedCentral
38.
go back to reference Oeser C, Lamagni T, Heath PT, et al. The epidemiology of neonatal and pediatric candidemia in England and Wales, 2000-2009. Pediatr Infect Dis J. 2013;32(1):23–6.PubMed Oeser C, Lamagni T, Heath PT, et al. The epidemiology of neonatal and pediatric candidemia in England and Wales, 2000-2009. Pediatr Infect Dis J. 2013;32(1):23–6.PubMed
39.
go back to reference Mellinghoff SC, Cornely OA, Jung N. Essentials in Candida bloodstream infection. Infection. 2018;46(6):897–9.PubMed Mellinghoff SC, Cornely OA, Jung N. Essentials in Candida bloodstream infection. Infection. 2018;46(6):897–9.PubMed
40.
go back to reference Cortes JA, Reyes P, Gomez CH, et al. Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogota, Colombia. Braz J Infect Dis. 2014;18(6):631–7.PubMed Cortes JA, Reyes P, Gomez CH, et al. Clinical and epidemiological characteristics and risk factors for mortality in patients with candidemia in hospitals from Bogota, Colombia. Braz J Infect Dis. 2014;18(6):631–7.PubMed
41.
go back to reference Wang H, Liu N, Yin M, et al. The epidemiology, antifungal use and risk factors of death in elderly patients with candidemia: a multicentre retrospective study. BMC Infect Dis. 2014;14:609.PubMedPubMedCentral Wang H, Liu N, Yin M, et al. The epidemiology, antifungal use and risk factors of death in elderly patients with candidemia: a multicentre retrospective study. BMC Infect Dis. 2014;14:609.PubMedPubMedCentral
42.
go back to reference Tedeschi S, Tumietto F, Giannella M, et al. Epidemiology and outcome of candidemia in internal medicine wards: a regional study in Italy. Eur J Intern Med. 2016;34:39–44.PubMed Tedeschi S, Tumietto F, Giannella M, et al. Epidemiology and outcome of candidemia in internal medicine wards: a regional study in Italy. Eur J Intern Med. 2016;34:39–44.PubMed
43.
go back to reference Gonzalez-Lara MF, Torres-Gonzalez P, Cornejo-Juarez P, et al. Impact of inappropriate antifungal therapy according to current susceptibility breakpoints on Candida bloodstream infection mortality, a retrospective analysis. BMC Infect Dis. 2017;17(1):753.PubMedPubMedCentral Gonzalez-Lara MF, Torres-Gonzalez P, Cornejo-Juarez P, et al. Impact of inappropriate antifungal therapy according to current susceptibility breakpoints on Candida bloodstream infection mortality, a retrospective analysis. BMC Infect Dis. 2017;17(1):753.PubMedPubMedCentral
Metadata
Title
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
Authors
Zhangrui Zeng
Yinhuan Ding
Gang Tian
Kui Yang
Jian Deng
Guangrong Li
Jinbo Liu
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2020
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-020-00798-3

Other articles of this Issue 1/2020

Antimicrobial Resistance & Infection Control 1/2020 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.