Analysis of fungal bloodstream infection in intensive care units in the Meizhou region of China: species distribution and resistance and the risk factors for patient mortality

Abstract

Background: Fungal bloodstream infections (FBI) among intensive care unit (ICU) patients are increasing. Our objective was to characterize the fungal pathogens that cause bloodstream infections and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China. Methods: Eighty-one ICU patients with FBI during their stays were included in the study conducted from January 2008 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and ROC curve analysis were used to assess the risk factors for mortality among the cases. Results: The prevalence of FBI in ICU patients was 0.38% (81/21,098) with a mortality rate of 36% (29/81). Ninetyeight strains of bloodstream-infecting fungi, mainly Candida spp., were identified from these patients. Candida albicans was most common (43%). Two strains of C. parapsilosis were no-sensitive to caspofungin, C. glabrata were less than 80% sensitive to azole drugs. Logistic multiple regression showed that age, serum albumin, APACHE II score, three or more underlying diseases, and length of stay in ICU were independent risk factors for mortality in FBI. ROC curve analysis showed that APACHE II scores > 19 and serum albumin ≤25 g/L were the best predictors of mortality. Conclusion: Candida spp. predominated with high mortality rates among cases of FBI in ICU. Thus, clinical staff should enhance overall patient monitoring and concurrently monitor fungal susceptibility to reduce mortality rates.

Prevalence of biofilms in Candida spp. bloodstream infections: A meta-analysis

“…Invasive mycoses are responsible every year for more than two million infections worldwide and for, at least, as many deaths as tuberculosis or malaria. Candidiasis, aspergillosis, cryptococcosis, and pneumocystosis cause more than 90% of reported deaths associated with invasive mycoses [ 18 ]. Among them, the most frequent mycosis is invasive candidiasis causing high morbidity in critically ill patients [ 19 ].…”

Clinical features and Outcomes of Cryptococcemia patients with and without HIV infection

“…Hypoalbuminemia manifested profound effects on the outcomes of patients with cryptococcemia, which might be explained by the following facts: (a) serum albumin is recognised as an indicator of progress and prognosis in many diseases, such as liver cirrhosis, 30,31 CKD, 32,33 autoimmune disease 34 and even fungal infection diseases 35 . In our study, many cryptococcemia patients exhibited predisposing diseases, so it was reasonable that hypoalbuminemia was associated with predisposing diseases and Cryptococcus infection; (b) serum albumin levels could greatly change the pharmacokinetics of AmB and voriconazole in critically ill adult patients 36‐38 .…”

Retrospective assessment of fungal pathogens isolated from various clinical samples in a tertiary care hospital in Turkey: A cross-sectional study

“…In a study conducted in China, the most common fungal pathogens isolated from blood cultures between 2007 and 2018 were C. albicans, C. tropicalis, C. glabrata, and C. parapsilosis, with rates of 43%, 18%, 12%, and 9%, respectively. It also was noted that the Fungal pathogens in a tertiary hospital in Turkey P a g e | 365 prevalence of C. albicans decreased, while other Candida species were increased each year [18].…”

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