The epidemiology and antifungal susceptibility of invasive Candida isolates in Southern Sichuan

Abstract

Abstract: Objective To analyze species distribution, sample types and antifungal susceptibility of invasive Candida infection, to provide basis for clinical diagnosis and treatment. Methods The clinical data of patients with invasive Candida infection were retrospectively analyzed in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2019. Results A total of 646 patients with non-repetitive invasive Candida infection were collected, including 355 males (54.95%) and patients over 60 years old (55.11%). The main isolates of Candida species were Candida albicans (314, 48.61%), followed by Candida glabrata (226, 34.98%) and Candida tropicalis (71, 10.99%). The number of infection patients was the highest in 2017 (141 cases, 21.83%), and then showed a downward trend. The main specimen types were deep wound secretion (229 cases, 35.45%), followed by clean urine (174 cases, 26.93%) and blood (117 cases, 18.11%). The top three departments of invasive Candida infection were internal medicine (255 cases, 39.47%), surgery (214 cases, 33.13%) and pediatrics (78 cases, 12.07%). The total resistance rates of all Candida species to fluconazole, itraconazole and voriconazole were 18.82%, 36.15% and 19.38%, respectively, and the susceptibilities of amphotericin B and 5-flucytosine was 100.00%. Conclusions Candida albicans was the main invasive infection species in this area and elderly patients were the main infected group.Non-Candida albicans was the main Candida species. Candida species were highly resistant to azole antifungal drugs, but highly sensitive to amphotericin B and 5-flucytosine.

Key words: invasive infection, Candida, epidemiology, antifungal susceptibility test, retrospective analysis

CLC Number:

R519.3

XU Lingling, ZENG Zhangrui, DING Yinhuan, YANG Kui. The epidemiology and antifungal susceptibility of invasive Candida isolates in Southern Sichuan[J]. Chinese Journal of Mycology, 2021, 16(5): 319-325.

References

[1] Kullberg BJ, Arendrup MC. Invasive candidiasis[J]. N Engl J Med, 2015, 373(15):1445-1456.
[2] Gong X, Luan T, Wu X, et al. Invasive candidiasis in intensive care units in China:Risk factors and prognoses of Candida albicans and non-albicans Candida infections[J]. Am J Infect Control, 2016, 44(5):e59-e63.
[3] McCarty TP, Pappas PG. Invasive candidiasis[J]. Infect Dis Clin North Am, 2016, 30(1):103-124.
[4] Chen M, Xu Y, Hong N, et al. Epidemiology of fungal infections in China[J]. Front Med, 2018, 12(1):58-75.
[5] 中华医学会"念珠菌病诊治策略高峰论坛"专家组. 念珠菌病诊断与治疗:专家共识[J]. 中国感染与化疗杂志, 2011, 11(2):81-95.
[6] Pu S, Niu S, Zhang C, et al. Epidemiology, antifungal susceptibilities, and risk factors for invasive candidiasis from 2011 to 2013 in a teaching hospital in southwest China[J]. J Microbiol Immunol Infect, 2017, 50(1):97-103.
[7] Ding X, Yan D, Sun W, et al. Epidemiology and risk factors for nosocomial non-Candida albicans candidemia in adult patients at a tertiary care hospital in North China[J]. Med Mycol, 2015, 53(7):684-690.
[8] Alkharashi N, Aljohani S, Layqah L, et al. Candida bloodstream infection:changing pattern of occurrence and antifungal susceptibility over 10 years in a tertiary care saudi hospital[J]. Can J Infect Dis Med Microbiol, 2019, 2019:2015692.
[9] Israel S, Amit S, Israel A, et al. The epidemiology and susceptibility of candidemia in Jerusalem, Israel[J]. Front Cell Infect Microbiol, 2019, 9:352.
[10] Tsay SV, Mu Y, Williams S, et al. Burden of candidemia in the United States, 2017[J]. Clin Infect Dis, 2020, 71(9):e449-e453.
[11] Vasilyeva NV, Raush ER, Rudneva MV, et al. Etiology of invasive candidosis agents in Russia:a multicenter epidemiological survey[J]. Front Med, 2018, 12(1):84-91.
[12] Jia X, Li C, Cao J, et al. Clinical characteristics and predictors of mortality in patients with candidemia:a six-year retrospective study[J]. Eur J Clin Microbiol Infect Dis, 2018, 37(9):1717-1724.
[13] Lin S, Chen R, Zhu S, et al. Candidemia in adults at a tertiary hospital in China:Clinical characteristics, species distribution, resistance, and outcomes[J]. Mycopathologia, 2018, 183(4):679-689.
[14] Xiao Z, Wang Q, Zhu F, et al. Epidemiology, species distribution, antifungal susceptibility and mortality risk factors of candidemia among critically ill patients:a retrospective study from 2011 to 2017 in a teaching hospital in China[J]. Antimicrob Resist Infect Control, 2019, 8:89.
[15] Xiao M, Sun ZY, Kang M, et al. Five-year national surveillance of invasive candidiasis:Species distribution and azole susceptibility from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study[J]. J Clin Microbiol, 2018, 56(7):e00577-18.
[16] Kato H, Yoshimura Y, Suido Y, et al. Mortality and risk factor analysis for Candida blood stream infection:A multicenter study[J]. J Infect Chemother, 2019, 25(5):341-345.
[17] Khan Z, Ahmad S, Al-Sweih N, et al. Changing trends in epidemiology and antifungal susceptibility patterns of six bloodstream Candida species isolates over a 12-year period in Kuwait[J]. PLoS One, 2019, 14(5):e0216250.
[18] 范欣, 郭莉娜, 杨洋, 等. 侵袭性感染酵母菌流行病学及耐药性分析[J]. 中国真菌学杂志, 2020, 15(1):10-14.
[19] 刘文静, 孙宏莉, 张小江, 等. 2014-2018年北京协和医院酵母菌血流感染菌种分布和抗真菌药物敏感性分析[J]. 中国真菌学杂志, 2019, 14(6):357-361.
[20] Santolaya ME, Thompson L, Benadof D, et al. A prospective, multi-center study of Candida bloodstream infections in Chile[J]. PLoS One, 2019, 14(3):e0212924.
[21] Cuenca-Estrella M, Verweij PE, Arendrup MC, et al. ESCMID^* guideline for the diagnosis and management of Candida diseases 2012:diagnostic procedures[J]. Clin Microbiol Infect, 2012:18(Suppl 7):9-18.
[22] Ullmann A, Cornely O, Donnelly J, et al. ESCMID^* guideline for the diagnosis and management of Candida diseases 2012:developing European guidelines in clinical microbiology and infectious diseases[J]. Clin Microbiol Infect, 2012, 18(Suppl 7):1-8..
[23] Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 62(4):e1-50.
[24] 荣辰, 田素飞, 褚云卓. 326株念珠菌血症病原菌种分布和药敏结果分析[J]. 中国医科大学学报, 2018, 47(9):773-777.
[25] 慧慎, 建郭, 旻张, 等. 上海地区临床分离念珠菌的耐药性监测[J]. 中国感染与化疗杂志, 2019, 19(3):292-299.
[26] Papadimitriou-Olivgeris M, Spiliopoulou A, Kolonitsiou F, et al. Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009-2017) in a university Greek hospital[J]. Infection, 2019, 47(2):209-216.
[27] Spiers R, Smyth B, Lamagni T, et al. The epidemiology and management of candidemia in Northern Ireland during 2002-2011, including a 12-month enhanced case review[J]. Med Mycol, 2019, 57(1):23-29.
[28] Tan TY, Hsu LY, Alejandria MM, et al. Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region[J]. Med Mycol, 2016, 54(5):471-477.