Analysis Of Clinical Characteristics And Risk Factors For Nosocomial Candidemia Patients

Background:Candidemia is one of the four most common nosocomial blood infection and was the most common hospital-acquired fungemia in a recent multi-institutional study from the US.The mortality of candidemia can be up to 50%,and annual healthcare costs were beyong $2 billion.Some researchers found that species distribution of Candida spp.and its antifugal sensitivity varied widely,thus studies for local region can provide the guiding opinions which were more closer to clinical practice.Aim:This study was conducted by retrospectively analyzing 159 clinical data of nosocomial candidemia patients.The aim is to analyze clinical characteristics of these patients and to investigate risk factors influencing the prognosis.Method:Patients were selected with retrospective study method and who fulfilling the following criteria were eligible for inclusion:(1)older than 18 years of age;(2)hospitalized in Guanghzou Nanfang hospital between January 1,2008 and Decembers 1,2014;(3)microbiologically confirmed candidemia during their hospitalization;(4)no data pertinent to the study missing from their EMR.For patients with multiple candidemia during the study period,only the first episode of bloodstream infection was analyzed.Result:A total of 159 cases with candidemia were identified.99(62.3%)were male.39(24.50%)were died.The median age of patients was 52.0 years.The median length of hospital stay was 35 days.The most common pathogens were Candida albicans(n=58,36.5%),and the most common non-albicans Candida spp.was Candida parapsilosis(n=39,24.5%).The drug resistance rate of Candicda spp.to fluconazole was the highest(16.4%)among the four antifungal drugs(fluconazole,fluorocytosine,itraconazole,amphotericin B).Ratio of using vasopressin before sampling,organ failure and candidemia which last more than 7 days of death group were 10.7%(17/39),71.80%(28/39),63.3%(19/39)respectively.And the values were significantly higher than those of survival roup,i.c 8.2%(13/120),24.2%(29/120),30.0%(30/120)respectively(all P<0.05).Logistic regression analysis showed that cerebirovascular diseases(OR=9.225,P=0.003),SOFA score within 72h after sampling(OR=1.136,P=0.009),organ failure(OR=10.116,P=0.001)and candidemia which last more than 7 days(OR=2.81,P=0.049)were independent risk factors for death.Conclusion:Candida albicans is the most common pathogen in candidemia.Echinocandin should be considered as the first-line drug to treat candidemia in Guangzhou area according to the guidelines.C.erebrovascular diseases,SOFA score within 72 hours after sampling,organ failure and andidemia which last more than 7 days are independent risk factors for nosocomial candidemia patients.