| Purpose:This study was divided into two parts,The first part was a retrospective analysis of the medical records of 181 inpatients with candidemia that was conducted to evaluate the species distribution and possible differences between BSI caused by Candida albicans and non-Candida albicans.The second part was detection of candida mannan antigen,antibody IgG and antibody IgM for 270 sera of candidemia group and control group,to evaluate the diagnostic value of three methods.Methods:The first part was a retrospective study.We analyzed 181 cases of hospitalized patients with candidemia from January 2009 to December 2017 in Sir Run Run Shaw Hospital(SRRSH)affiliated with the Zhejiang University School of Medicine.Demographic data,basic diseases,invasive operation and surgical procedures,distribution departments,and the number of cases in different periods were evaluated.The statistical significance of the risk factors between Candida albicans and non-Candida albicans was analyzed by chi-square test.The second part evaluated the value of candida mannan antigen,antibody IgG and antibody IgM for diagnosis of candidemia.A total of 270 serum samples from 56 patients were collected in SRRSH from November 2016 to October 2017.The sensitivity,specificity and AUC curve of three methods were evaluated,and the diagnostic value were analyzed.Results:Among the 181 cases in the first part,the incidence of candidemia increased year by year,mainly due to increased infection of non-Candida albicans.The age of patients ranged from 14 to 94,and most of them were over 50 years old.In the distribution departments,the top three were the general surgery,urology and hematology departments.In the clinical features,the top three were central venous catheter placement,parenteral nutrition and ICU admission.Of the 189 Candida species,42.86%were Candida albicans and 57.14%were non-Candida albicans.Candida tropicalis and Candida parapsilosis were prominent in non-Candida albicans.Of the patients with chest surgery or abdominal surgery,30 cases were Candida albicans infection,66 cases were non-Candida albians infection,and P value was 0.0014.Of the patients with hematological malignancy,1 case was Candida albicans infection,13 cases were non-Candida albians infection,and P value was 0.0050.Of the patients used azole antifungal drugs,2 cases were Candida albians infection,11 cases were non-Candida albians infection,and P value was 0.0381.These three risk factors are statistically significant.The second part contain two experimental groups:candidemia group and control group.Candida mannan antigen,antibody IgG and antibody IgM were test in two groups.The results showed that the sensitivity of candida mannan antigen experiment was 84.21%and the specificity was 81.08%.The AUC area under the curve was 0.8265(95%CI 0.7207-0.9322).The specificity of combined detection of candida mannan antigen and antibody IgG was 94.59%.The concentration of candida mannan antigen,antibody IgG and antibody IgM did not decrease or increase with the prolongation of treatment.Conclusions:The incidence rate of candidemia showed an upward trend,and the proportion of different species causing candidemia has shifted toward non-Candida albicans.Candidemia mosthly occurs in patients who age ≥50 years.Candidemia patients are mainly come from general surgery,urology and hematology departments.Chest surgery or abdominal surgery,hematological malignancy,and used azole antifungal drugs were the main risk factors among patients with non-Candida albians candidemia.In this study,AUC area under the curve of candida mannan antigen detection were higher,the sensitivity and specificity was good.The specificity of combined detection of candida mannan antigen and antibody IgG was highest.But follow-up study by detecting the concentration of candida mannan antigen,antibody IgG and antibody IgM is not valued in the prolongation of treatment. |
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