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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

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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 -
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