Clinical epidemiology and prognostic analysis of nosocomial candidemia / 中国感染与化疗杂志

ABSTRACT

Objective To analyze the clinical features,etiology and prognostic factors of nosocomial candidemia in Beijing Anzhen Hospital.Methods A total of 174 cases of nosocomial candidemia identified during the period from January 2003 to December 2013 in Anzhen Hospital were reviewed retrospectively.The underlying conditions,risk factors,clinical manifestations and outcome were described and analyzed.The prognostic factors were analyzed by both univariate analysis including t-test and Chisquare test,and multivariate regression analysis.Results The 174 patients included 108 (62.1％) males and 66 (37.9％) females.The mean age of patients was 53.9±27.3 years,specifically＜18 years (31/174,17.8％),18-＜ 65 years (56/174,32.2％),and ≥ 65 years (87/174,50.0％).About one-third (59/174,33.9％) of the patients were treated in ICU,followed by cardiac surgery ward (58/174,33.3％),respiratory medicine ward (21 / 174,12.1％),general surgery ward (14/174,8.0％),neurology ward (7/174,4.0％),vascular surgery (6/174,3.4％),and orthopedic ward (3/174,1.7％).Fever was documented in all cases,including 37.5-37.9 ℃ in 3 (1.7％) cases,38.0-38.9 ℃ in 81 (46.6％) cases,39.0-39.9 ℃ in 85 (48.9％) cases,and ≥ 40.0 ℃ in 5 (2.9％) cases.Increased peripheral blood WBC (＞10×109/L) was reported in 162 (93.1％) cases.The percentage of neutrophils (＞75％) was reported in 166 (95.4％) cases.Thrombocytopenia (＜ 100 × 109/ L) was documented in 24 (13.8％) cases.The most frequently isolated pathogen was C.albicans (99/174,56.9％),followed by C.parapsilosis (37/174,21.3％),C.glabrata (20/174,11.5％),C.krusei (11/174,6.3％),C.tropicalis (4/174,2.3％),and other Candida spp.(3/174,1.7％).The death rate was 50.0％ (87/174).Univariate analysis showed that old age,thrombocytopenia,hypoalbuminemia,renal insufficiency,indwelling urinary catheter were associated with death of candidemia patients.Multivariate analysis showed that hypoalbuminemia,bacterial co-infection,and indwelling urinary catheter were independent risk factors of death in nosocomial candidemia.Conclusions Nosocomial candidemia is more common in the patients treated in ICU and surgery ward.The most common pathogen of nosocomial candidemia is C.albicans associated with high mortality.Old age,hypoalbuminemia,bacterial co-infection,and indwelling urinary catheter are associated with death in nosocomial candidemia.