Epidemiology and Risk Factors of Candidemia a 8-Year Retrospective Study from a Teaching Hospital in China

Figures & data

Figure 1 Annual change in incidence risk per 1000 hospital admissions of candidemia, 2015–2022. The figure showed the change in the total incidence of candidemia and the incidence rate of two major types of candidemia in our study.

Figure 2 Distribution of Candida species isolates, 2015–2022. The most prevalent species was Candida albicans, followed by Candida glabrata, Candida parapsilosis, Candida tropicalis and others Candida spp.

Table 1 Antifungal Susceptibility of Candida Spp. Isolated

	S (%)	SDD/I (%)	R (%)
C. albicans (n=55)
Fluconazole	94.5	5.5	0.0
Voriconazole	98.2	0.0	1.8
C. glabrata (n=41)
Fluconazole	0.0	100.0	0.0
Voriconazole	NA	NA	NA
C. parapsilosis (n=28)
Fluconazole	96.4	3.6	0.0
Voriconazole	100.0	0.0	0.0
C. tropicalis (n=18)
Fluconazole	55.6	5.6	38.8
Voriconazole	72.2	0.0	27.8

Abbreviations: S, susceptible; SDD/I, susceptible dose-dependent/intermediate; R, resistant; NA, non-applicable.

Table 2 Overall Characteristics and Univariate Analysis of Mortality in Patients with Candidemia

Variables	Total n = 134 (%)	Death n = 44 (%)	Survived n = 90 (%)	p value
Age, years
≥65	75 (56.0)	35 (79.5)	40 (44.4)	<0.001
<65	59 (44.0)	9 (20.5)	50 (55.6)
Gender
Male	78 (58.2)	29 (65.9)	49 (54.4)	0.206
Female	56 (41.8)	15 (34.1)	41 (45.6)
Hospital stay, days, mean±SD	41.9±54.4	40.6±46.6	42.5±58.0	0.853
Underlying diseases
Pulmonary disease	72 (53.7)	30 (68.2)	42 (46.7)	0.019
Cardiovascular disease	66 (49.3)	27 (61.4)	39 (43.3)	0.050
Diabetes mellitus	47 (35.1)	23 (52.3)	24 (26.7)	0.004
Chronic liver disease	4 (3.0)	0 (0.0)	4 (4.4)	0.302
Chronic kidney disease	24 (17.9)	11 (25.0)	13 (14.4)	0.135
Solid tumor	88 (65.7)	27 (61.4)	61 (67.8)	0.539
Neurologic diseases	31 (23.1)	11 (25.0)	20 (22.2)	0.720
Shock	31 (23.1)	23 (52.3)	8 (8.9)	<0.001
APACHE II score, mean±SD	16.9±8.3	23.5±8.2	13.7±6.3	<0.001
Invasive Procedure
Abdominal surgery	68 (50.7)	18 (40.9)	50 (55.6)	0.111
Central venous catheter	132 (98.5)	44 (100.0)	88 (97.8)	1.000
Mechanical ventilator	34 (25.4)	14 (31.8)	20 (22.2)	0.231
Urinary catheter	89 (66.4)	33 (75.0)	56 (62.2)	0.141
Body cavity drainage tube	49 (36.6)	15 (34.1)	34 (37.8)	0.677
Total parenteral nutrition	100 (74.6)	32 (72.7)	68 (75.6)	0.724
Before candidemia
Broad-spectrum antibiotic use	133 (99.3)	43 (97.7)	90 (100.0)	0.328
Corticosteroid use	73 (54.5)	23 (52.3)	50 (55.6)	0.720
After candidemia
Antifungal therapy	114 (85.1)	29 (65.9)	85 (94.4)	0.001
Laboratory findings
C-reactive protein (mg/L), mean±SD	89.2±62.8	107.0±75.3	80. 6±54.1	0.021
Procalcitonin (ng/L), mean±SD	14.1±31.9	21.4±40.1	10.4±26.3	0.069
Albumin (g/l), mean±SD	36.8±38.5	39.5±64.2	35.5±14.6	0.571
White blood cells (×109/L), mean±SD	9.3±5.4	11.7±6.3	8.2±4.5	<0.001

Abbreviations: SD, standard deviation; APACHE II, Acute Physiology and Chronic Health Evaluation II; CVC, Central venous catheter; TPN, Total parenteral nutrition.

Figure 3 Kaplan–Meier survival analysis for candidemia. Patients treated with antifungal drugs and patients not treated with antifungal drugs were included (p<0.001).

Table 3 Multivariate Analysis of Factors Associated with 30-Day Mortality in Patients with Candidemia

Factor	OR (95% CI)	P
Age≥65	3.874 (1.146, 13.092)	0.029
Shock	3.428 (1.097, 10.719)	0.034
APACHE II	12.384 (2.963, 51.762)	0.001
Antifungal therapy	0.057 (0.011, 0.306)	0.001
White blood cells	1.129 (1.016, 1.255)	0.024

Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II; OR, odds ratio; CI, confidence interval.