Analysis of clinical characteristics and risk factors for 92 cases of nosocomially acquired candidemia

Objective To investigate the clinical features and prognostic factors of nosocomially acquired candidemia. Methods A retrospective analysis was conducted for hospitalized patients with nosocomial candidemia between January 2012 and December 2014 at the First Affiliated Hospital of Anhui Medical University. The univariate and multivariate Logistic regression analyses were used to determine the prognostic factors of candidemia. Results A total of 92 patients were diagnosed with nosocomially acquired candidemia. The most common pathogen was Candida glabrata (C. glabrata, 39/92, 42.4%), followed by Candida albicans (C. albicans, 30/92, 32.6%), then Candida krusei (C. krusei, 7/92, 7.6%), Candida tropicalis (C. tropicalis, 5/92, 5.4%), Candida parapsilosis (C. parapsilosis, 4/92, 4.4%) and other Candida spp. (7/92, 7.6%). The sensitivity rates of Candida spp. strains against flucytosine, amphotericin B, voriconazole, fluconazole and itraconazol were 100.0%, 98.9%, 92.4%, 82.6% and 77.2%, respectively. The 30-day attributable case fatality rate was 13.0%(12/92). Multivariate Logistic regression analyses indicated that presence of central venous catheter (OR=4.833, 95%CI: 1.010-23.125, P=0.049), invasive mechanical ventilation (OR=6.075, 95%CI: 1.144-32.257, P=0.034), and receiving hemodialysis (OR=8.367, 95%CI: 1.390-50.364, P=0.020) were factors independently correlated with increased mortality. Conclusions The pathogens causing nosocomially acquired candidemia are mainly C. glabrata, C. albicans and C. krusei. The drug susceptibility of Candida spp. varies among fluconazole, itraconazol voriconazole. The resistant rates of Candida spp. against voriconazole, fluconazole and itraconazol are different. The presence of central venous catheter, invasive mechanical ventilation and receiving hemodialysis are factors independently correlated with increased mortality. Key words: Candidemia; Drug resistance; Risk factors; Prognosis