A Ten-year Retrospective Study of Invasive Candidiasis in a Tertiary Hospital in Beijing

Abstract

Objective: This study aimed to evaluate the epidemiological, clinical and mycological characteristics of invasive candidiasis (IC) in China.

Methods: A ten-year retrospective study including 183 IC episodes was conducted in a tertiary hospital in Beijing, China.

Results: The overall incidence of IC from 2010-2019 was 0.261 episodes per 1,000 discharges. Candidemia (71.0%) was the major infective pattern; 70.3% of the patients tested positive for Candida spp. colonization before IC and the median time to develop an invasive infection after colonization was 13.5 days (interquartile range: 4.5-37.0 days). Candida albicans (45.8%) was the most prevalent species, followed by Candida parapsilosis (19.5%), Candida glabrata (14.2%) and Candida tropicalis (13.7%). C. non- albicans IC was more common in patients with severe anemia ( P = 0.018), long-term hospitalization ( P = 0.015), hematologic malignancies ( P = 0.002), continuous administration of broad-spectrum antibiotics ( P < 0.001) and mechanical ventilation ( P = 0.012). In vitro resistance testing showed that 11.0% of the Candida isolates were resistant/non-wild type (non-WT) to fluconazole, followed by voriconazole (9.6%), micafungin (3.8%), and caspofungin (2.9%). Fluconazole was the most commonly used drug to initiate antifungal therapy both before and after the proven diagnosis (52.6% and 54.6%, respectively). The 30-day and 90-day all-cause mortality rates were 24.5% and 32.7%, respectively.

Conclusion: The incidence of IC has declined in the recent five years. C. non- albicans contributed to more than half of the IC cases. Fluconazole can be used as first-line therapy if resistant strains are not prevalent. Prospective, multi-center surveillance of the clinical and mycological characteristics of IC is required.

Keywords: Antifungal resistance; Epidemiology; Invasive candidiasis; Mortality; Risk factors; Treatment.