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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1063-1069. doi: 10.19723/j.issn.1671-167X.2018.06.022

• Article • Previous Articles     Next Articles

Clinical analysis of candidemia in immunocompetent patients

Yan-ling DING,Ning SHEN(),Qing-tao ZHOU,Bei HE,Jia-jia ZHENG,Xin-mao ZHAO   

  1. 1. Department of Respiratory Medicine, 2. Department of Laboratory Medicine, 3. Department of Nosocomial Infection,Peking University Third Hospital, Beijing 100191, China
  • Received:2017-10-17 Online:2018-12-18 Published:2018-12-18
  • Contact: Ning SHEN E-mail:shenning1972@126.com

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Abstract:

Objective: To investigate the etiological and clinical characteristics of immunocompetent patients with candidemia.Methods:The clinical and microbiological data of patients diagnosed as candidemia admitted in Peking University Third Hospital from January 2010 to June 2016 were retrospectively analyzed. Underlying diseases, Candida spp. colonization, clinical manifestations, microbiological data, treatment and the outcome were compared between the HIV-negative immunocompromised (IC) and nonimmunocompromised (NIC) patients.Results:A total of 62 cases diagnosed as candidemia were analyzed including 36 men and 26 women, with 16 to 100 years of age [(66.02±17.65) years]. There were 30 NIC and 32 HIV-negative IC patients respectively. In the NIC patients, there were 19 cases (19/30, 63.33%) with admission in intensive care unit (ICU), 21 (21/30, 70.00%) associated diabetes mellitus or uncontrolled hyperglycemia and 22(22/30,73.33%)receiving invasive mechanical ventilation,while in the HIV-negative IC patients, there were 8 (8/32, 25.00%),13 (13/32, 40.63%) and 7 (7/32, 21.88%) respectively (P<0.05). The NIC patients had higher acute physiology and chronic health evaluation (APACHEⅡ) scores and sequential organ failure assessment (SOFA) scores both at admission (19.98±5.81, 6.04±6.14) and candidemia onset (25.61±6.52, 12.75±8.42) than the HIV-negative IC patients (APACHEⅡ 15.09±5.82, 22.15±5.98) and SOFA 2.87±2.73, 7.66±5.64 respectively (P<0.05). In the NIC patients, twenty-one cases (21/30, 70.00%) died in hospital,while 14 cases (14/32, 43.75%) in HIV-negative IC.The crude mortality was significantly different between the two groups (P<0.05). By blood culture, Canidia albicans remained the the most prevalent isolates in all the patients. Clinical manifestation, Candida spp. colonization, etiology and drug susceptibility were also similar between NIC and HIV-negative IC patients (P>0.05).Conclusion:Candidemia in NIC patients tends to occur in those who are much more critically ill, more often admitted in ICU, and more frequently have diabetes mellitus or uncontrolled hyperglycemia and receive invasive mechanical ventilation than HIV-negative IC patients. NIC patients also have poorer prognosis than HIV- negative IC patients. Clinical manifestations, and microbiological characteristics are similar between HIV- negative IC and NIC patients.

Key words: Candida, Candidemia, Immunocompetent patients, Clinical manifestation, Prognosis

CLC Number: 

  • R56

Table 1

Clinical data of nonimmunocompromised and HIV- negative immunocompromised patients with candidemia"

Clinical data Nonimmunocompromised patients
(n=30)		 HIV-negative immunocompromised
patients (n=32)		 P
Admission in ICU, n(%) 19 (63.33) 8 (25.00) 0.002
Underlying diseases
Malignant solid tumor or hematologic disease, n(%) 0 (0.00) 26 (81.25) <0.001
Diabetes mellitus or uncontrolledhyperglycemia, n(%)
Peritoneal infection, n(%)
Acute or chronic renal failure, n(%)		 21 (70.00)
4 (13.33)
15 (50.00)		 13 (40.63)
7 (21.88)
11 (34.38)		 0.020
0.379
0.213
Hypoalbuminemia, n(%) 28 (93.33) 26 (81.25) 0.156
Neutropnia, n(%)
Multiple sites colonization with Candida spp., n(%)		 0 (0.00)
22 (73.33)		 7 (21.88)
20 (62.50)		 0.011
0.362
Treatment measures
Presence of a central venous catheter, n(%) 28 (93.33) 27 (84.38) 0.427
Presence of a ureter, n(%) 28 (93.33) 31 (96.88) 0.607
Presence of peritoneal drainage pipes, n(%) 7 (23.33) 10 (31.25) 0.485
Prior abdominal surgery, n(%)
Prior surgery, n(%)		 7 (23.33)
12 (40.00)		 12 (37.50)
14 (43.75)		 0.227
0.765
Parenteral nutrition, n(%) 12 (40.00) 15 (46.88) 0.585
Invasive mechanical ventilation, n(%) 22 (73.33) 7 (21.88) <0.001
Hemodialysis, n(%) 2 (6.67) 4 (12.50) 0.672
Systemic corticosteroids or cytotoxic drugs use, n(%)
Cancer chemotherapy, n(%)		 0 (0.00)
0 (0.00)		 12 (37.50)
15 (46.88)		 <0.001
<0.001
Broad-spectrum antibiotic use, n(%) 29 (96.67) 27 (84.38) 0.197
Prior antifungal exposure, n(%)
Disease severity
APACHE Ⅱ score at admission, x-±s
APACHE Ⅱ score at candidemia, x-±s
SOFA score at admission, x-±s
SOFA score at candidemia, x-±s
Sever sepsis, n(%)
Septic shock, n(%)
Multiple organ failure, n(%)		 2 (6.67)

19.98±5.81
25.61±6.52
6.04±6.14
12.75±8.42
26 (86.67)
19 (63.33)
16 (53.33)		 5 (15.63)

15.09±5.82
22.15±5.98
2.87±2.73
7.66±5.64
29 (90.63)
14 (43.75)
12 (37.50)		 0.427

0.048
0.037
0.011
0.007
0.623
0.122
0.211

Table 2

Susceptibility of Candida spp. isolated from nonimmunocompromised and HIV- negative immunocompromised patients to antifungal agents"

Candida spp. Antifungal agents Nonimmunocompromised patients (n=30) HIV-negative immunocompromised patients (n=32) P
No. of strains S I R No. of strains S I R
Candida albicans Fluconazole 17 17 0 0 16 15 0 1 0.485
Itraconazole 15 1 1 12 0 4 0.249
Flucytosin 17 0 0 16 0 0 1.000
Amphotericin B 17 0 0 16 0 0 1.000
Voriconazole 17 0 0 15 1 0 0.485
Candida tropicalis Fluconazole 5 3 2 0 9 6 0 3 0.083
Itraconazole 4 0 1 5 1 3 1.000
Flucytosin 5 0 0 9 0 0 1.000
Amphotericin B 5 0 0 9 0 0 1.000
Voriconazole 3 2 0 5 1 3 0.287
Candida glabrata Fluconazole 6 6 0 0 4 4 0 0 1.000
Itraconazole 3 3 0 3 1 0 0.571
Flucytosin 6 0 0 4 0 0 1.000
Amphotericin B 6 0 0 4 0 0 1.000
Voriconazole 6 0 0 4 0 0 1.000
Candida parapsilosis Fluconazole 2 2 0 0 2 2 0 0 1.000
Itraconazole 2 0 0 1 1 0 1.000
Flucytosin 2 0 0 2 0 0 1.000
Amphotericin B 2 0 0 2 0 0 1.000
Voriconazole 2 0 0 2 0 0 1.000
Candida krusei Fluconazole 0 - - - 1 0 0 1 -
Itraconazole - - - 1 0 0 -
Flucytosin - - - 1 0 0 -
Amphotericin B - - - 1 0 0 -
Voriconazole - - - 1 0 0 -
[1] 李光辉 . 念珠菌血症的诊断与抗真菌治疗[J]. 中国感染与化疗杂志, 2011,11(2):98-100.
[2] Wisplinhoff H, Bischoff T, Tallent SM , et al. Nosocomial bloodstream infections in US hospitals: analysis of 24, 179 cases from a prospective nationwide surveillance study[J]. Clin Infect Dis, 2004,39(3):309-317.
doi: 10.1086/421946
[3] Wang H, Xiao M, Chen SC , et al. In vitro susceptibilities of yeast species to fluconazole and voriconazole as determined by the 2010 national China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study[J]. J Clin Microbiol, 2012,50(12):3952-3959.
doi: 10.1128/JCM.01130-12 pmid: 23035204
[4] Guery BP, Arendrup MC, Auzinger G , et al. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part I. Epidemiology and diagnosis[J]. Intensive Care Med, 2009,35(1):55-62.
doi: 10.1007/s00134-008-1339-6 pmid: 18972100
[5] Dimopoulos G, Karabinis A, Samonis G , et al. Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study[J]. Eur J Clin Microbiol Infect Dis, 2007,26(6):377-384.
doi: 10.1007/s10096-007-0316-2 pmid: 17525857
[6] Giri S, Kindo AJ . A review of Candida species causing blood stream infection[J]. Indian J Med Microbiol, 2012,30(3):270-278.
doi: 10.4103/0255-0857.99484 pmid: 22885191
[7] Mikulska M, Bassetti M, Ratto S , et al. Invasive candidiasis in non-hematological patients[J]. Mediterr J Hematol Infect Dis, 2011,3(1):e2011007.
doi: 10.4084/MJHID.2011.007 pmid: 21625311
[8] Safdar A, Bannister TW, Safdar Z . The predictors of outcome in immunocompetent patients with hematogenous candidiasis[J]. Int J Infect Dis, 2004,89(3):180-186.
doi: 10.1016/j.ijid.2003.05.003 pmid: 15109594
[9] Vigouroux S, Morin O, Moreau P , et al. Candidemia in patients with hematologic malignancies: analysis of 7 years’ experience in a single center[J]. Haematologica, 2006,91(5):717-718.
[10] Charlson ME, Pompei P, Ales KL , et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation[J]. J Chronic Dis, 1987,40(5):373-383.
doi: 10.1016/0021-9681(87)90171-8 pmid: 3558716
[11] Marra AR, Bearman GM, Wenzel RP , et al. Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa[J]. BMC Infect Dis, 2006,17(6):132.
doi: 10.1186/1471-2334-6-132 pmid: 1563469
[12] León C, Ruiz-Santana S, Saavedra P , et al. EPCAN study group. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization[J]. Crit Care Med, 2006,34(3):730-737.
doi: 10.1097/01.CCM.0000202208.37364.7D pmid: 16505659
[13] Posteraro B, De Pascale G, Tumbarello M , et al. Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1→3)-β-D-glucan assay, Candida score, and colonization index[J]. Crit Care, 2011,15(5):R249.
doi: 10.1186/cc10507 pmid: 22018278
[14] Abe M, Kimura M, Araoka H , et al. Serum (1, 3)-beta-D-glucan is an inefficient marker of breakthrough candidemia[J]. Med Mycol, 2014,52(8):835-840.
doi: 10.1093/mmy/myu066 pmid: 25349254
[15] Singer M, Deutschman CS, Seymour CW , et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016,315(8):801-810
doi: 10.1001/jama.2016.0287 pmid: 26903336
[16] 陈佰义 . 侵袭性念珠菌病早期经验治疗的临床思维[J]. 中华内科杂志, 2014,53(11):907-909
doi: 10.3760/cma.j.issn.0578-1426.2014.11.019
[17] Sims CR, Ostrosky-Zeichner L, Rex JH . Invasive candidiasis in immunocompromised hospitalized patients[J]. Arch Med Res, 2005,36(6):660-671
doi: 10.1016/j.arcmed.2005.05.015 pmid: 16216647
[18] Tragiannidis A, Tsoulas C, Kerl K , et al. Invasive candidiasis: update on current pharmacotherapy options and future perspectives[J]. Expert Opin Pharmacother, 2013,14(11):1515-1528.
doi: 10.1517/14656566.2013.805204 pmid: 23724798
[19] Ahmad S, Khan Z . Invasive candidiasis: a review of nonculture-based laboratory diagnostic methods[J]. Indian J Med Microbiol, 2012,30(3):264-269.
doi: 10.4103/0255-0857.99482 pmid: 22885190
[20] 谢剑锋, 杨毅 . 重症医学科患者念珠菌血症早期诊断的困境与思路[J]. 中华内科杂志, 2015,54(5):456-457.
doi: 10.3760/cma.j.issn.0578-1426.2015.05.016
[21] Del Bono V, Delfino E, Furfaro E , et al. Clinical performance of the (1, 3)-β-D-glucan assay in early diagnosis of nosocomial Candida bloodstream infections[J]. Clin Vaccine Immunol, 2011,18(12):2113-2117.
doi: 10.1128/CVI.05408-11 pmid: 21994353
[22] Jaijakul S, Vazquez JA, Swanson RN , et al.( 1, 3)-β-D-glucan as a prognostic marker of treatment response in invasive candidiasis[J]. Clin Infect Dis, 2012,55(4):521-526.
doi: 10.1093/cid/cis456 pmid: 22573851
[23] Lewis RE . Overview of the changing epidemiology of candidemia[J]. Curr Med Res Opin, 2009,25(7):1732-1740.
doi: 10.1185/03007990902990817 pmid: 19519284
[24] Pemán J, Cantón E, Miñana JJ , et al. Changes in the epidemiology of fungaemia and fluconazole susceptibility of blood isolates during the last 10 years in Spain: results from the FUNGEMYCA study[J]. Rev Iberoam Micol, 2011,28(2):91-99.
doi: 10.1016/j.riam.2011.02.005
[25] 吴吉芹, 朱利平, 区雪婷 , 等. 医院获得性念珠菌血症109例临床特点及预后分析[J]. 中华传染病杂志, 2011,29(4):206-210.
doi: 10.3760/cma.j.issn.1000-6680.2011.04.003
[26] Playford EG, Nimmo GR, Tilse M , et al. Increasing incidence of candidaemia: long-term epidemiological trends, Queensland, Australia, 1999-2008[J]. J Hosp Infect, 2010,76(1):46-51.
doi: 10.1016/j.jhin.2010.01.022 pmid: 20382444
[27] Pfaller MA, Messer SA, Moet GJ , et al. Candida bloodstream infections: comparison of species distribution and resistance to echinocandin and azole antifungal agents in intensive care unit (ICU) and non-ICU settings in the SENTRY Antimicrobial surveillance program (2008-2009)[J]. Int J Antimicrob Agents, 2011,38(1):65-69.
doi: 10.1016/j.ijantimicag.2011.02.016 pmid: 21514797
[28] Marriott DJ, Playford EG, Chen S , et al. Australian candidaemia study. Determinants of mortality in non-neutropenic ICU patients with candidaemia[J]. Crit Care, 2009,13(4):R115.
doi: 10.1186/cc7964 pmid: 19594912
[29] Tumbarello M, Posteraro B, Trecarichi EM , et al. Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia[J]. J Clin Microbiol, 2007,45(6):1843-1850.
doi: 10.1128/JCM.00131-07 pmid: 17460052
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