Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai — A retrospective of 11-year clinical analysis in a shanghai tertiary hospital

Background: Candida spp. are important opportunist pathogens causing bloodstream infections (BSIs). The present study aims to describe the current epidemiology of Candida BSI in a large Shanghai Tertiary-care Hospital from 2008 to 2018 and to identify the risk factors and the impact of antifungal therapy on clinical outcomes. Methods: From January 2008 to December 2018, all consecutive patients who developed Candida BSI at Ruijin Hospital were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and its impact on the outcome were analyzed. Results: The incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients, and the overall 28-day mortality rate was 28.5%. Among the 393 cases of Candida BSI, 299 cases (76.1%) received antifungal therapy. 247 received early appropriate antifungal therapy (an appropriate drug with adequate dosage was started before the subsequent in vitro susceptibility results), and 52 received target antifungal therapy (appropriate target treatment started after susceptibility results, regardless of whether the inappropriate antifungal treatment has been initialed or not). The 28-day mortality rate was significantly lower in those who received early appropriate antifungal therapy or target antifungal therapy compared with those who did not receive antifungal therapy (25.5% and 23.1% vs. 39.4%,P = 0.012 and P = 0.046). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, neutropenia were independent risk factors for the 28-day mortality rate, while antifungal therapy was a protective factor for short-term survival rate. Conclusions: The epidemiology of Candida BSI in Shanghai differed from that observed in Western countries. Antifungal therapy did influence the short-term survival, while there was no significant difference between the mortality for those who received early appropriate antifungal therapy and for those who received target antifungal therapy.