Candidemia in Adults at a Tertiary Hospital in China: Clinical Characteristics, Species Distribution, Resistance, and Outcomes

Lin, Shaoming; Chen, Ruilan; Zhu, Song; Wang, Huijun; Wang, Lianfang; Zou, Jian; Yan, Jun; Zhang, Xiangdong; Farmakiotis, Dimitrios; Tan, Xiaojiang; Mylonakis, Eleftherios

doi:10.1007/s11046-018-0258-5

Cited by 26 publications

(28 citation statements)

References 58 publications

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“…In accordance with other studies [17-19, 24, 25, 30, 32, 35, 36], C. albicans was the most common cause of candidaemia in the whole hospital, but the proportion of non-C. albicans infections was higher than that of C. albicans infections. Moreover, the proportions of C. glabrata in surgical, internal medicine and paediatric wards were the highest, which is different from other studies in China [18,19,[35][36][37] but similar to other studies in other countries [4,22,27,29,32]. This may be due to the large number of elderly patients and the increasing use of azole antifungal agents.…”

Section: Discussioncontrasting

confidence: 90%

“…Our data showed that the median age of patients with candidaemia and the proportion of males were similar to those in other studies [8,[18][19][20][21][22][23]. Moreover, our study showed that the patients with candidaemia were hospitalised mostly in internal medicine wards, which is different from other studies that reporting hospitalisation mainly in ICU wards [8,22,[24][25][26][27], but similar to other studies [28][29][30][31].…”

Section: Discussionsupporting

confidence: 84%

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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

Zeng

Ding

Tian

et al. 2020

Antimicrob Resist Infect Control

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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.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionsupporting

confidence: 84%

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

Zeng

Ding

Tian

et al. 2020

Antimicrob Resist Infect Control

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show abstract

Section: Discussioncontrasting

confidence: 88%

“…Moreover, FCA was highly active against all Candida species in paediatric patients and could be used in paediatric patients with candidaemia as a rst-line agent. In the whole hospital, the resistance rate to azole was higher than those reported in other regions [18,19,36] and countries [17,19,25,29,30,34]. This may be related to the long-term use of empirical prophylactic drugs by clinicians.…”

Section: Discussionmentioning

confidence: 70%

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

Zeng

Ding

Tian

et al. 2020

Preprint

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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 1,000 admissions (0.42 cases per 1,000 paediatric admissions vs 0.24 cases per 1,000 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.

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“…This phenomenon is most likely due to the widespread and increasingly common utilization of echinocandins, especially as they are currently recommended as the first-line antifungal for treatment of invasive candidiasis ( 9 – 12 ). After C. albicans , C. parapsilosis is the second or third most common cause of invasive candidiasis depending on the geographical location ( 5 , 13 , 14 ). In fact, previous exposure to echinocandins is a risk factor for C. parapsilosis infections, as this species manifests naturally higher MIC values to the three clinically available echinocandins (caspofungin [CAS], anidulafungin [AND], and micafungin [MICA]) compared to other Candida species ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Echinocandin-Induced Microevolution of Candida parapsilosis Influences Virulence and Abiotic Stress Tolerance

Papp

Kocsis

Tóth

et al. 2018

mSphere

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Candida parapsilosis is an opportunistic fungal pathogen with the ability to cause infections in immunocompromised patients. Echinocandins are the currently recommended first line of treatment for all Candida species. Resistance of Candida albicans to this drug type is well characterized. C. parapsilosis strains have the lowest in vitro susceptibility to echinocandins; however, patients with such infections typically respond well to echinocandin therapy. There is little knowledge of acquired resistance in C. parapsilosis and its consequences on other characteristics such as virulence properties. In this study, we aimed to dissect how acquired echinocandin resistance influences the pathogenicity of C. parapsilosis and to develop explanations for why echinocandins are clinically effective in the setting of acquired resistance.

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Candidemia in Adults at a Tertiary Hospital in China: Clinical Characteristics, Species Distribution, Resistance, and Outcomes

Cited by 26 publications

References 58 publications

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

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

A seven-year surveillance study of the epidemiology, antifungal susceptibility, risk factors and mortality of candidaemia among paediatric and adult inpaitents in a tertiary teaching hospital in China

Echinocandin-Induced Microevolution of Candida parapsilosis Influences Virulence and Abiotic Stress Tolerance

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