Abstract
Objective
Candidemia leads to higher mortality and longer hospital-stay. While the studies about the clinical manifestations of candidemia caused by different Candida species and the relationship between the antifungal drugs and prognosis were rarely performed.
Methods
This retrospective study enrolled all 94 patients diagnosed as candidemia from January 2020 to July 2023 in BTCH. Demographic information, comorbidities, laboratory parameters, medications and prognosis were collected and analyzed.
Results
C. albicans was the most common specie of candidemia. There was no significant difference in age, gender and hospital-mortality in different species groups. Higher-level and longer duration of broad-spectrum antibiotic use, lower BMI, hypoalbuminemia, longer duration of PN and history of G+ coccemia were conclusive about mortality. The C.tropicalis group had higher SCRE levels (F = 8.40, P = 0.03) and shorter TTP (F = 5.03, P < 0.01) than other species. No distinction was found in different antifungal drugs groups including triazoles and echinocandins after 7 days treatment (χ2 = 0.05, P = 0.81). The efficacy was no difference between triazoles and echinocandins in the different species groups. (χ12 = 1.20, P1 = 0.75; χ22 = 0.05, P2 = 0.81).
Conclusion
C. albicans accounts the most among candida induecd candidemia.The C.tropicalis group had higher SCRE levels and shorter TTP than other groups. Elder, hypoproteinemia, lower BMI, longer duration and higher-level of broad-spectrum antibiotic use, longer PN support and G+ coccemia increase risks for candidemia. The efficacy of triazoles and echinocandins are the same when blood culture turned negative in 7 days.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12879-024-10128-2.
Keywords: Candidemia, Candida, Antifugal treatment, Triazoles, Echinocandins
Background
Candidemia, which is an opportunistic infection, ranks fourth among the major bloodstream infectious diseases that threaten public health, and its highest rate reaches 2.23 cases/10000. The increasing incidence of this disease leads to longer hospital stays and higher mortality rates. Studies have shown that the length of the hospital stay has increased by approximately 5 days and that the mortality can reach more than 50–70%. Moreover, the cost of treatment of candidemia can reach 1 billion [1–6]. Therefore, it is important for clinicians to investigate candidemia in modern times.
Among the species that cause candidemia, C. albicans accounts for the greatest percentage of cases, reaching 50%, followed by C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei [2, 7–13]. An increasing number of studies have shown that the incidence rate of C. glabratainfection has increased rapidly in recent years, reaching 30% from 17% in previous years [2, 8–10, 13].
Candidemia often occurs in immunodeficiency individuals, such as people with immune system diseases and malignancies, and those receiving radiotherapy, chemotherapy and corticosteroid therapy. Hypoalbuminemia, central venous catheterization (CVC), parenteral nutrition(PN), and abdominal surgery have been shown to be risk factors for candidemia [2–16]. Candida invade into blood by localized infection, the damaged gastrointestinal mucosal barrier and an intravascular catheter, then inducing candidemia. Its clinical manifestations and laboratory results are atypical, especially for different Candida species.
The main antifugal drugs for candidemia are triazoles, echinocandins, and amphotericin B. Among them, triazoles and echinocandins are the most widely-used in clinical practice. Considering the increasing trend of triazole resistance, multiple studies have recommended echinocandins as first-line treatment for candidemia [9, 12, 17, 18]. However, effectiveness of medications among candidemia which induced by different Candida spp. were seldom performed.
We reviewed the studies published in the last 5 years on PubMed, Embase and Google Scholar and found that few studies aimed at clinical practice of candidemia. Moreover, most of these studies, which were performed in Europe and America, focused on the epidemiology and risk factors for candidemia. There are few studies in Asia. In addition, studies on the epidemiology, clinical features, treatment and prognosis of candidemia induced by different Candida species are lacking. We conducted this research to determine the epidemiology and clinical characteristics of candidemia in Asia and to understand the differences between candidemia induced by different species.
Materials and methods
Definitions
Surveillance case definition
Candidemia diagnosis was confirmed by at least one positive blood culture yielding Candidaspecies growth [5]. The diagnostic criteria for central line-associated bloodstream infection (CLABSI) were as follows: clinical signs of infection; no alternative source of bloodstream infection; and a positive blood culture from a peripheral vein with any one of the following: a catheter tip/segment culture that matches the organism grown from the blood; at least a threefold greater number of organisms grown from the catheter versus the peripheral blood culture on simultaneously drawn cultures; and growth from the catheter-drawn blood culture occurring at least 2 h earlier than the growth of the same organism from a percutaneously drawn blood culture [19].
Variables assessed
A history of gastrointestinal surgery or urinary tract surgery indicated that the surgery occurred within 1 month. Broad-spectrum antibiotic use was limited to 1 month. High-level broad-spectrum antibiotics included carbapenems and β-lactams/enzyme inhibitors, and low-level broad-spectrum antibiotics included cefotaxime and levofloxacin in this study. A history of G+ coccemia indicated that the patients were diagnosed within 10 days, but the blood culture was negative at enrollment.
Study design
Data collection
This study was conducted in Beijing Tsinghua Changgung Hospital (BTCH) affiliated with Tsinghua University, which is a general and teaching hospital. According the “International Ethical Guidelines for Biomedical Research Involving Human Subjects (2002)” and “Helsinki Declaration (2013)”, Ethics Committee of the Beijing Tsinghua Changgung Hospital approved this research and agreed that informed consent was not available due to this was a retrospective study and all the data were collected through the electronic hospital information system (HIS) of the BTCH.
This was a retrospective study. The medical records of patients were reviewed through the HIS of the BTCH. The demographic data of the patients (sex, age, etc.), comorbidities, risk factors for candidemia, vital signs at onset, laboratory findings, microbiological data, medications and prognoses were collected in this study.
Laboratory methods
Blood cultures were evaluated via a Bruker Microflex LT/SH automated system. The positive fungal samples were transferred to blood agar plates and Sappaul plate, modified Shadomy agar fungal susceptibility plate and French Cormagar chromogenic medium and cultured in an incubator at 35℃ for 48–72 h. Then they subjected to bacterial identification using VITEK 2-COMPACT automatic microbial analyzer. Instrument culture for 5 days without alarm was negative.Susceptibility testing procedures of antifungal drugs followed clinical and laboratory standards institute (CLSI) M27(2017). Time to positivity (TTP) was defined as the time interval from the beginning of blood culture incubation to the blood culture positive alert.
Enrollment strategy
Using “candidemia” as a keyword, we searched the Critical Result Alert System of HIS and ultimately identified 143 patients from January 2020 to July 2023. Patients were enrolled if they met the following criteria: 1) age≧18 years; 2) had complete clinical data; 3) had a single-species infection according to blood culture. The exclusion criteria were as follows: 1) take antifungal drugs in 1 month; 2) 2 or more Candida infections according to blood culture; 3) concomitant bacteremia; 4)undertaken candidemia and blood culture haven’t turned negative.
A total of 94 patients, including 59 males and 35 females, were enrolled in this study (Fig. 1).In our research, we identified the following four Candida species: C. albicans, C. parapsilosis, C. tropicalis, and C. glabrata. The patients were distributed into different groups according to the different pathogen results (Fig. 1).
Fig. 1.
Research strategy
Outcomes
Treatment success was the first negative blood culture after treatment for at least 14 days. Blood cultures of all patients were negative after 14 days of treatment, except for those who died during our study. Therefore, we adopted a 7-day blood culture for negative results as a standard to evaluate the efficacy of the drug. Mortality was considered to occur within 28 days after the diagnosis of candidemia.
Statistical analysis
Statistical analysis was performed with the SPSS 25.0 software. Count data are expressed as the percentage of the number of patients, and crosstabs were used for multigroup comparisons. Normally distributed data are expressed as the mean ± standard deviation (x ± s), and a t-test was used for comparisons between two groups of data. ANOVA was used for comparisons of the average values among multiple groups of data. Nonnormally distributed data are expressed as the medians and interquartile ranges, M (Q25, Q75), and a nonparametric test was used to analyze data among multiple groups. Logistic regression analysis was used to analyze the relationships between the observed indicators and patient prognosis. At P < 0.05, the difference was considered clinically significant.
Results
Patients’ characteristics and species distribution
The average age at onset was 66.36 ± 13.88 years overall, no significant difference was observed in different genders (t = -0.09, P = 0.92). In this study, 22 patients (23.40%) died (Table 1). C. albicans was the prevalent species in our study, accounted for 46.8% of all while C. parapsilosis accounted for 23.4%, C. glabrata accounted for 17.0%, and C. tropicalis accounted for 12.8% of the cases (44 vs. 22 vs. 16 vs. 12).
Table 1.
Patients’ characteristics and species distribution
| Items | C. albicans | C. parapsilosis | C. glabrata | C. tropicalis | Overall | Result (χ2/F) | P |
|---|---|---|---|---|---|---|---|
| Number | 44 | 22 | 16 | 12 | 94 | - | - |
| Male | 31(70.45) | 15(68.18) | 7(43.75) | 6(50.00) | 59(62.76) | 4.70 | 0.19 |
| Age(years old) | (66.61 ± 1.89) | (66.68 ± 2.61) | (63.68 ± 4.26) | (68.08 ± 5.11) | (66.31 ± 13.88) | 0.26 | 0.85 |
| Malignant Tumor | 18(40.91) | 8(36.36) | 5(31.25) | 6(50.00) | 37 | 1.13 | 0.76 |
| Billary surgerya | 12(27.27) | 2(9.09) | 2(12.50) | 4(33.33) | 18 | 5.19 | 0.15 |
| Gastrointestinal surgerya | 14(31.81) | 9(40.91) | 10(62.50) | 3(25.00) | 36 | 5.70 | 0.12 |
| Urethra surgerya | 4(9.09) | 2(9.09) | 2(12.50) | 2(16.67) | 10 | 0.68 | 0.87 |
| PNa | 25(56.81) | 11(50.00) | 10(62.50) | 4(33.33) | 50 | 2.78 | 0.42 |
| Broad-spectrum antibiotic usea | 27(61.36) | 10(45.45) | 10(62.50) | 3(25.00) | 50 | 6.09 | 0.10 |
| Chemotherapya | 3(6.81) | 1(4.54) | 1(6.25) | 1(8.33) | 6 | 0.21 | 0.97 |
| Diabetes | 6(13.63) | 9(40.91) | 3(18.75) | 1(8.33) | 19 | 8.09 | 0.04 |
| COPD | 2(4.54) | 1(4.54) | 1(6.25) | 3(25.00) | 7 | 6.20 | 0.10 |
| Heart disease | 3(6.81) | 5(22.72) | 1(6.25) | 1(8.33) | 10 | 4.44 | 0.21 |
| CKD | 2(4.54) | 1(4.54) | 2(12.50) | 1(8.33) | 6 | 1.45 | 0.69 |
| Mental disease | 4(9.09) | 2(9.09) | 1(6.25) | 1(8.33) | 8 | 0.13 | 0.98 |
| Cirhosis | 4(9.09) | 1(4.54) | 1(6.25) | 1(8.33) | 7 | 0.48 | 0.92 |
| Immune diseaseb | 1(2.27) | 0(0.00) | 0(0.00) | 1(8.33) | 2 | - | - |
| G+coccemia | 12(27.27) | 9(40.91) | 5(31.25) | 4(33.33) | 30 | 1.27 | 0.73 |
| CVCb | 9(20.45) | 5(22.72) | 3(18.75) | 3(25.00) | 20 | 0.45 | 0.92 |
| ICUb | 16(36.36) | 12(54.55) | 7(43.75) | 6(50.00) | 41 | 4.00 | 0.26 |
| Death | 10(22.73) | 5(22.72) | 2(12.50) | 5(41.67) | 22 | 3.31 | 0.34 |
aHistory of billary surgery,gastrointestinal surgery,broad-spectrum antibiotic use,urinary tract surgery,chemotherapy and parenteral nutrition support(PN) in 1 month
bCVC plantation and ICU-admission within 2 weeks
There were no significant differences in the ages at onset, ICU admission or mortality of patients among the different Candida species (F1 = 0.26, P1 = 0.85; F2 = 3.31, P2 = 0.34, respectively) (Table 1). In addition, during the process of data collection, 30 patients (31.91%) presented with gram-positive (G+) coccemia within 10 days (Table 1).
Risk factors for candidemia
Broad-spectrum antibiotic use, the low body mass index (BMI), the low albumin (ALB) level, PN support, a history of gastrointestinal surgery, a history of urinary tract surgery and a history of G+ coccemia were the risk factors for death in the patients with candidemia (Table 2). The longer the duration of PN was, the higher the mortality rate was (OR 10.57, 95% CI 0.45–0.82; P < 0.01). In terms of the recent broad-spectrum antibiotic use, the patients were divided into a low-level antibiotic group and a high-level antibiotic group. The level of antibiotic use, duration of antibiotic treatment (coefficient of correlation: 0.91, P < 0.01) and mortality rate were positively correlated.
Table 2.
Logistic regression analysis of risk factors
| Items | Wals | 95% OR | P |
|---|---|---|---|
| Broad-spectrum antibiotic use | 7.27 | 0.01 ~ 1.54 | < 0.01 |
| lower BMI | 7.92 | 1.10 ~ 1.93 | < 0.01 |
| Hypoproteinemia | 6.10 | 0.93 ~ 1.32 | 0.04 |
| PN | 5.27 | 0.17 ~ 29.99 | 0.02 |
| Gastrointestinal surgery | 2.94 | 0.10 ~ 25.63 | 0.04 |
| Urinary tract surgery | 4.41 | 0.20 ~ 39.71 | 0.03 |
| G+ coccemia | 3.41 | 0.04 ~ 1.09 | 0.04 |
| ICU-admissona | 0.79 | 0.56 ~ 4.28 | 0.40 |
| CVCa | 0.60 | 0.21 ~ 1.97 | 0.44 |
| Elder | 6.31 | 0.86 ~ 0.98 | 0.01 |
aCVC plantation and ICU-admission within 2 weeks
Clinical manifestation and laboratory parameters in different species
Fever was the main clinical manifestation, while the mean arterial pressure (MAP) was normal at the time of onset, and there were no differences among the different Candida spp. (Table 3). In this study, 74 patients completed β-D-glucan (BDG) examination (MB80-M,Gold Mountainriver), but the percentage of patients with positive results was only 66.22% (49 vs. 25).
Table 3.
Clinical presentation and laboratory parameters in differents species
| Items | C. albicans | C. parapsilosis | C. glabrata | C. tropicalis | Overall | Result (F/H) | P |
|---|---|---|---|---|---|---|---|
| BMI(kg/m2) | (22.62 ± 0.52) | (22.00 ± 0.67) | (20.84 ± 0.95) | (20.79 ± 0.74) | (21.92 ± 0.34) | 1.63 | 0.18 |
| T(oC) | (38.22 ± 0.15) | (37.95 ± 0.20) | (37.92 ± 0.21) | (37.93 ± 0.12) | (38.07 ± 0.09) | 0.89 | 0.45 |
| MAP(mmHg) | (106.40 ± 2.32) | (105.68 ± 2.79) | (102.62 ± 3.29) | (107.16 ± 5.03) | (105.93 ± 1.46) | 0.37 | 0.77 |
| WBC(109/L) | (10.47 ± 0.72) | (6.92 ± 0.99) | (7.76 ± 0.71) | (11.90 ± 2.88) | (9.30 ± 0.53) | 3.95 | 0.01 |
| N(U/L) | (9.27 ± 0.78) | (4.68 ± 0.86) | (5.52 ± 0.62) | (11.38 ± 0.29) | (7.77 ± 0.61) | 5.70 | 0.01 |
| Y(U/L) | (0.69 ± 0.06) | (0.94 ± 0.12) | (0.68 ± 0.13) | (0.79 ± 0.11) | (0.76 ± 0.05) | 1.25 | 0.29 |
| HB(g/L) | (95.40 ± 2.91) | (97.81 ± 3.41) | (88.68 ± 5.71) | (88.16 ± 5.86) | (94.03 ± 1.96) | 1.20 | 0.31 |
| PLT(1012/l) | (144.89 ± 16.48) | (192.90 ± 23.79) | (148.31 ± 21.69) | (140.50 ± 29.47) | (140.50 ± 19.22) | 0.37 | 0.77 |
| PCT(ng/L) | (0.41,2.89) | (0.32,3.02) | (0.27,1.65) | (0.46,4.53) | (0.35,2.76) | 3.95 | 0.26 |
| CRP(mg/L) | (44.75,131.00) | (24.25,84.00) | (29.50,80.80) | (13.75,152.75) | (27.50,113.50) | 2.35 | 0.50 |
| AST(U/L) | (20.75,72.20) | (24.12,67.25) | (26.12,46.75) | (16.50,79.87) | (21.55,61.85) | 0.14 | 0.98 |
| CRE(mmol/L) | (46.22,102.75) | (47.75,126.50) | (49.25,159.00) | (94.25,206.00) | (50.25,143.50) | 8.40 | 0.03 |
| ALB(g/L) | (30.75 ± 0.71) | (31.29 ± 1.07) | (29.35 ± 1.35) | (28.83 ± 1.27) | (30.35 ± 0.49) | 0.98 | 0.40 |
| TTP(hour) | (45.16 ± 3.34) | (33.18 ± 3.82) | (39.56 ± 5.04) | (22.16 ± 3.80) | (38.44 ± 2.14) | 5.03 | < 0.01 |
C-reactive protein (CRP) and procalcitonin (PCT) were increased, whereas the lymphocyte count and the serum ALB and hemoglobin (HB) levels were decreased. The white blood cell (WBC) counts were significantly greater in the C. albicans and C. tropicalis groups (F = 3.95, P = 0.01) than in the other groups. Moreover, the C. tropicalis group had a higher serum creatinine (SCRE) level and a shorter TTP (F1 = 8.40, P1 = 0.03; F2 = 5.03, P2 < 0.01, respectively). There were no significant differences in the ages, BMIs, body temperature or MAP, PCT, CRP, WBC, HB, platelet (PLT), lymphocyte, transaminase (AST), or ALB levels among the different pathogen groups (Table 3).
Efficacy of antifungals drugs
Triazoles, echinocandins and amphotericin B (54 vs. 37 vs. 3) were used as antifungal medicines in this study. Triazoles, which included fluconazole and voriconazole, were used to treat 57.45% of the patients, and fluconazole was the most commonly used medicine (35 vs. 19). Echinocandins, which included mainly caspofungin, were used to treat 39.36% of the patients. Seventy-one patients, including 1 patient treated with amphotericin B and 70 patients treated with triazoles and echinocandins, undertook blood cultures again after 7 days of treatment. The efficacy of triazoles was similar to that of echinocandins (χ2 = 0.05, P = 0.81) in 7-day-treatment. After the efficacies of triazoles and echinocandins across the four groups were compared, no measurable differences were detected (χ12 = 1.20, P1 = 0.75; χ22 = 0.05, P2 = 0.81, respectively) (Table 4).
Table 4.
Efficacy of triazoles and echinocandins in 7 days treatment
| Triazoles | Echinocandins | Overall | |||
|---|---|---|---|---|---|
| Effective | Non-effective | Effective | Non-effective | ||
| C. albicans | 17 | 3 | 14 | 1 | 35 |
| C. parapsilosis | 4 | 2 | 7 | 2 | 15 |
| C. glabrata | 6 | 1 | 4 | 1 | 12 |
| C. tropicalis | 3 | 1 | 3 | 1 | 8 |
| Overall | 30 | 7 | 28 | 5 | 70 |
Overall:χ2 = 0.05, P = 0.81;Triazoles: χ2 = 1.20,P = 0.75;Echinocandins: χ2 = 1.58, P = 0.66
Discussion
Candidemia is a critical illness that increases hospitalization and mortality rates, as well as the economic burden. C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, C. krusei, C. kefyr and C. dubliniensis are the most common species leading to candidemia. Although recent studies have shown that the incidence of C. glabrata infection has increased sharply, reaching approximately 30%, C. albicans is still the predominant pathogen, followed by C. glabrata, C. parapsilosis and C. tropicalis [1–10]. In our study, the species that we identified were only C. albicans, C. parapsilosis, C. glabrata, and C. tropicalis, and there were no differences in the age, gender or comorbidities among the groups of patients. Similar to other studies, C. albicans accounted for the most of cases (46.8%) in this study. However, C. parapsilosis was more common than C. glabrata (22 vs. 16 cases). Compared with the other species, C. parapsilosis ranked second.
Elder, immunosuppressive drug use (glucocorticoids, chemotherapeutic drugs, etc.), parenteral nutrition (PN) therapy, abdominal surgery (billary, gastrointestinal and urethra tract surgery), malignance, hypoproteinemia, CVC plantation and ICU admission are the risk factors for candidemia [4–17]. Most of these factors were associated with the risk of candidemia in our study, with the exceptions of CVC and ICU admission (Table 2). Although we did not enroll the APACHE II score, studies have reported that the APACHE II score correlated with the prognosis of candidemia [8]. In addition to these normal risk factors, the lower BMI and a recent history of G+ coccemia also increase mortality of candidemia. Notably, 31.91% of the patients had a history of G+ coccemia within 10 days before the onset of candidemia. G+ coccemia increases vascular permeability, accelerating the entry of Candida into the bloodstream.Severe bacteremia can cause immunosuppression, and high-level broad-spectrum antibiotics also contribute to risk for candidemia. On the basis of studies indicating that broad-spectrum antibiotic use increases the risk of candidemia, we divided broad-spectrum antibiotics into low-level broad-spectrum antibiotics and high-level broad-spectrum antibiotics, and found that higher-level broad-spectrum antibiotic use and longer-duration of antibiotic use could increase the risk of mortality. Candida spp. usually colonize the gastrointestinal tract, and PN increases the risk for candidemia because PN may lead to damage to the intestinal barrier and microbial translocation, which could explain why a longer duration of PN was associated with a higher mortality rate in our research(OR 10.57, 95% CI 0.45–0.82, P < 0.01).
The detection of candidemia lacks specificity. Fever was the most common symptom that was observed in the present study. Liang and Stelios noted that increased WBC counts, PCT and CRP levels were related to mortality in candidemia patients [8, 20]. In our study, the CRP and PCT levels and the WBC counts were increased but not related to mortality. Even though the WBC counts in the C. albicans and C. tropicalis groups were significantly greater (F = 3.95, P = 0.01) than those in the other groups, there were no significant differences in body temperature or MAP, PCT, CRP, WBC, HB, PLT, lymphocyte, AST, or ALB levels among the different pathogen groups. Therefore, from the perspective of symptoms and laboratory results, distinguishing the different Candidawas difficult. Most studies recommend BDG detection to help diagnose invasive candidiasis, especially candidemia, and this approach has a sensitivity of 87.1% and specificity of 96% [21–23]. In this study, 74 patients completed BDG examination, but the percentage of patients with positive results was only 66.22% (49 vs. 25), and there were no differences among the different species. The reason why the percentage less than most studies maybe that several patients received antifungal treatment before BDG detection.
Similar to TTP in most studies, the median TTP in this study was 38.44 ± 2.14 h. The C. tropicalis group had a shorter TTP (F = 5.03, P < 0.01) than that in the other groups (Table 3) [2, 24]. Arun proposed that the TTP could be used to detect C. glabrata and C. tropicalis, with sensitivities of 88% and 85%, respectively [24]. However, the TTP was longer in his study, which was shorter in our results. Therefore, whether the TTP could distinguish Candida species is still unknown. Studies have shown that C. tropicalisgrows faster than other species, with a larger number of cells in the blood, stronger antibiotic resistance, stronger mucosal penetration and the ability to easily form biofilms with strong adhesion [25, 26]. Considering that the higher SCRE level and the shorter TTP in the C. tropicalis group than in the other groups, we propose that the invasion ability of C. tropicalis may be greater than that of other Candida species.
Plent of studies have shown that urgent CVC removal is beneficial if the blood culture from CVC is positive [3, 7, 12]. The CVC was removed when CLABSI was considered in our research. And there were no differences among the four species (6 vs. 3 vs. 2 vs. 1, χ2= 0.19, P= 0.98) in CVC-removel. Most studies have recommended echinocandins as the first-line treatment for candidemia [2, 12, 27–31]. An increasing number of studies have focused on the resistance to antifungal drugs, especially for C. glabrata. Echinocandins have a low resistance rate of 2–3% in Candida except for C. glabratacompared with triazoles have a resistance rate of nearly 30% [9, 11, 12, 21, 28, 29]. Fluconazole resistance is present in approximately 8% of C. albicans strains and in as many as 26% of C. glabrata strains. C. glabratahas a high resistance rate of 8–13% on echinocandins and the rate showed higher than other species [13, 26]. There were no echinocandin-resistant Candida in our study, while 3 Candida which proved all of them were C. glabrata exhibited triazole resistance. On the basis of same percentage of CVC removals were performed in the triazole and echinocandin groups (6 vs. 6, χ2 = 0.53, P = 0.77), no difference was found between the treatments with triazoles and echinocandins (χ2 = 0.05, P = 0.81), with blood cultures showing negative results after 7 days in the different groups.
Limitations
1) As this was a retrospective and single-center study, only four Candida species enrolled; 2) The APACHE II score and the primary infection status of the patients were not analyzed; 3) The lack of long-term follow-up data prevented survival and prognosis analyses.
Conclusion
Candida albicans is the most prevalent species leading to candidemia. C.tropicalis group had higher SCRE levels and shorter TTP than other species. There are nearly no distinctions among the different Candida species in the fields of comorbidities, symptoms and most laboratory results. In addition to common risk factors such as elder and hypoproteinemia, lower BMI, longer duration and higher-level of broad-spectrum antibiotic use, longer PN support and G+ coccemia are risk factors for candidemia. In terms of treatment, the effective rates of triazoles and echinocandins are the same when blood culture turned negative in 7 days.
Supplementary Information
Acknowledgements
No.
Authors’ contributions
Chenguang Zhang was responsible for data collection, literature reviewing and paper writing. Wenshi Feng and Tao Yuan reviewed the statistical analysis and language revision of the revised manuscript. Xuyan Chen was responsible for the review and revision of the paper. Sheng Wu was responsible for paper writing and reviewing.Yiming Wang and Hao Yang contributed to the data collection of this research.
Funding
This research was supported by Special program of major epidemic prevention and control in Beijing (XKB2022B101).
Data availability
The datasets generated and analysed during the current study are not publicly available due the data is conducted for further research but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
According the “International Ethical Guidelines for Biomedical Research Involving Human Subjects (2002)” and “Helsinki Declaration (2013)”, Ethics Committee of the Beijing Tsinghua Changgung Hospital approved this research and informed consent was waived by Ethics Committee of the Beijing Tsinghua Changgung Hospital due to this was a retrospective study. (NO. 22542–6-01).
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
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Contributor Information
Sheng Wu, Email: maomaoapplecn@hotmail.com.
Xuyan Chen, Email: cxya00559@btch.edu.cn.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and analysed during the current study are not publicly available due the data is conducted for further research but are available from the corresponding author on reasonable request.