A Retrospective Clinical Research Of Nosocomial Aquired Candidemia

Objective:Retrospective analysis clinical features, prognostic risk factors, pathogenic factors influencing pathogen resistance characteristics of nosocomial aquired candidemia in Beijing Hospital of Ministry of Health from January1,2006to December31,2011.Methods:Retrospective analysis of the blood culture Candida-positive cases Beijing Hospital from January1,2006to2011December31, to collect general information, underlying diseases and risk factors, clinical features and laboratory tests data. Grouping (group of death vs non-death group, Candida albicans group vs non-Candida albicans group) corresponding to the clinical features, prognostic risk factors, risk factors affecting the distribution of candidemia pathogen. Analysis of the susceptibility changes of Candida from January2006December2011. Statistical analysis was performed using automatically spss19.0analysis.T test was used for normally distributed measurement datas. Non-parametric test was used for the non-normal distribution of measurement datas. The chi-square test or Fisher’s exact method were used for the count datas. Logistic regression analysis was used for multivariate analysis.Outcome:1. In this study65patients with candidemia were included. There were30Candida albicans cases, accounting for46.2%of the total number,22C. glabrata cases, accounting for33.8%of the total,9Candida tropicalis cases, accounting for13.8%of the total, and4parapsilosis cases, accounting for6.2%of the total. Average age was76±14years old. There were58cases older than65years, accounting for89.2%of the total number2.38cases were died among the65cases. Total mortality was58.5%.11cases were dead in7days and the7-days mortality was16.9%.27were died in30days and30-day mortality rate was41.5%, accounting for71.05%of the deaths (27/38).31deaths were directly related to candidemia, accounting for81.57%of the total deaths. Mean survival time was26.7days (0-112days). Shock (71.1%vs44.4%, P=0.031), APACHEII score (28.67vs20.11, P=0.002), APACHEII score)24points (55.3vs29.6, P=0.04), primary diagnosis time (from onset to the first positive results reporting time)(138.7hvs127.2h, P=0.019), positive blood culture frequency (2.95vsl.71times, P=0.011), indwelling central venous catheter (78.9%vs48.1%, P=0.010) and the indwelling abdominal catheters (13.2%vs44.4%, P=0.005) were significant differences between the death group and the survival group. Multivariate logistic regression analysis also showed that shock (OR3.513,95%CI1.005-12.277, P=0.049), APACHEII score (OR1.096,95%CI1.008-1.191, P=0.032), positive blood culture frequency (OR1.442,95%CI1.003-2.073, P=0.048) and primary diagnosis time (OR1.617,95%CI1.059-2.471, P=0.026) were independent risk factor for death, but continuous blood purification therapy(OR0.014,95%CI0.001-0.262, P=0.004) as an independent protective factors.3. Non-albicans were the majority pathogens of the cases. There were35non-albican cases, accounting for53.8%of the total. The total mortality rate (66.7%vs51.4, P=0.214),7-days mortality (20%vs12.3%, P=0.540) and30-days morttality(50%vs34.3%, P=0.214) of albican candidemia were higher than non-albican candidemia, but had no statistically significant. The average hospital days (49.3days vs81.2days, P=0.007)and the average survival time (26.1days vs40.4days, P=0.041) were statistically longer in the non-Candida albicans group. Multivariate logistic regression analysis showed that diabetes(OR4.43,95%CI1.32-14.83, P=0.016)was independent risk factors for non-Candida albicans infection, and indwelling central venous catheter(OR0.224,95%CI,0.061-0.816)was independent risk factor for Candida albicans infection.4. Among2006-2011, fluconazole was susceptible for all Candida albicans, but the resistance rate for C. Glabrata was10.3%, and the MIC for C. glabrata was gradually increased. Itraconazole was susceptible for all Candida albicans, but for C. Glabrata, the resistance rate was39.6%. Voriconazole was susceptible for all Candida albicans, but for Candida glabrata, the resistance rate was9.1%.Conclusion:1. Compared with death and survival group, shock, high APACHEII score, primary diagnosis time and indwelling central venous catheters increase the risk of death. Shock, APACHEII positive blood culture frequency and primary diagnosis time were independent risk factors for death. Continuous blood purification therapy was a protective factor.2. Compared with albican candidemia and non-albican candidemia, the majority candida of the candidemias in Our hospital was non-albican candidemia, C. glabrata was the most common. Non-albican candidemia had length average hospital days and the length average survival time than albican candidemia. Diabetes was the independent risk factor for non-Candida albicans infection, but indwelling central venous catheter was an independent risk factor for Candida albicans infection.3. Among2006-2011, Candida albicans isolated from candidemia was sensitive to all of the common antifungal drugs, such as5-fluorocytosine, amphotericin-B, azoles. All of the C. glabratas were sensitive to5fluorocytosine and amphotericin-B.The resistance rate to fluconazole for C. glabrata was10.3%. The resistance rate to itraconazole for C. glabrata was39.6%. The resistance rate to voriconazole for C. glabrata was9.1%. The fluconazole MIC values for C. glabrata gradually increased.