Invasive candidiasis in intensive care units in China: a multicentre prospective observational study
To describe the epidemiology, microbiology and management of invasive Candida infection (ICI) in intensive care units (ICUs) in China. A multicentre, prospective, observational study in 67 hospital ICUs across China. Patients were ≥18 years old with clinical signs of infection and at least one of th...
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| Veröffentlicht in: | Journal of antimicrobial chemotherapy 2013-07, Vol.68 (7), p.1660-1668 |
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| creator | Guo, Fengmei Yang, Yi Kang, Yan Zang, Bin Cui, Wei Qin, Bingyu Qin, Yingzhi Fang, Qiang Qin, Tiehe Jiang, Dongpo Li, Weiqin Gu, Qin Zhao, Hongsheng Liu, Dawei Guan, Xiangdong Li, Jianguo Ma, Xiaochun Yu, Kaijiang Chan, Dechang Yan, Jing Tang, Yaoqing Liu, Wei Li, Ruoyu Qiu, Haibo |
| description | To describe the epidemiology, microbiology and management of invasive Candida infection (ICI) in intensive care units (ICUs) in China.
A multicentre, prospective, observational study in 67 hospital ICUs across China. Patients were ≥18 years old with clinical signs of infection and at least one of the following diagnostic criteria: (i) histopathological, cytopathological or microscopic confirmation of yeast cells from a normally sterile site; (ii) at least one peripheral blood culture positive for Candida; and (iii) positive Candida culture from a normally sterile site. The China-SCAN study is registered with ClinicalTrials.gov (NCT T01253954).
ICI incidence was 0.32% (306 patients/96,060 ICU admissions) and median time between ICU admission and diagnosis was 10.0 days. Candida albicans was the most prevalent single isolate (41.8% of patients), although non-albicans species accounted for the majority of infections. Diagnostic confirmation was based solely on at least one positive blood culture in 290 (94.8%) cases. Treatment was initiated after diagnostic confirmation in 166/268 (61.9%) patients. Triazoles (62.7%) and echinocandins (34.2%) were the most commonly used antifungal agents; first-line therapy was typically fluconazole (37.7%). The median duration of antifungal therapy was 14 days. The mortality rate was 36.6% (112/306); the median time between diagnosis and death was 14.5 days. Mortality was higher in older individuals, those with solid tumours, those with recent invasive mechanical ventilation and those with a higher sequential organ failure assessment score at diagnostic confirmation. Susceptibility to first-line antifungals was associated with lower mortality than dose-dependent susceptibility or complete resistance (P=0.008).
More infections were caused by non-albicans than Candida albicans strains. The majority of patients were treated only after diagnostic confirmation, rather than empirically. First-line antifungal susceptibility was associated with lower mortality. |
| doi_str_mv | 10.1093/jac/dkt083 |
| format | Article |
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A multicentre, prospective, observational study in 67 hospital ICUs across China. Patients were ≥18 years old with clinical signs of infection and at least one of the following diagnostic criteria: (i) histopathological, cytopathological or microscopic confirmation of yeast cells from a normally sterile site; (ii) at least one peripheral blood culture positive for Candida; and (iii) positive Candida culture from a normally sterile site. The China-SCAN study is registered with ClinicalTrials.gov (NCT T01253954).
ICI incidence was 0.32% (306 patients/96,060 ICU admissions) and median time between ICU admission and diagnosis was 10.0 days. Candida albicans was the most prevalent single isolate (41.8% of patients), although non-albicans species accounted for the majority of infections. Diagnostic confirmation was based solely on at least one positive blood culture in 290 (94.8%) cases. Treatment was initiated after diagnostic confirmation in 166/268 (61.9%) patients. Triazoles (62.7%) and echinocandins (34.2%) were the most commonly used antifungal agents; first-line therapy was typically fluconazole (37.7%). The median duration of antifungal therapy was 14 days. The mortality rate was 36.6% (112/306); the median time between diagnosis and death was 14.5 days. Mortality was higher in older individuals, those with solid tumours, those with recent invasive mechanical ventilation and those with a higher sequential organ failure assessment score at diagnostic confirmation. Susceptibility to first-line antifungals was associated with lower mortality than dose-dependent susceptibility or complete resistance (P=0.008).
More infections were caused by non-albicans than Candida albicans strains. The majority of patients were treated only after diagnostic confirmation, rather than empirically. First-line antifungal susceptibility was associated with lower mortality.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkt083</identifier><identifier>PMID: 23543609</identifier><language>eng</language><publisher>England: Oxford Publishing Limited (England)</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antifungal Agents - therapeutic use ; Blood - microbiology ; Candida - classification ; Candida - isolation & purification ; Candida albicans ; Candidiasis, Invasive - epidemiology ; Candidiasis, Invasive - microbiology ; Cell culture ; China - epidemiology ; Disease management ; Epidemiology ; Female ; Fungal infections ; Hospitals ; Humans ; Incidence ; Intensive care ; Intensive Care Units ; Male ; Microbiology ; Middle Aged ; Prospective Studies ; Survival Analysis ; Treatment Outcome</subject><ispartof>Journal of antimicrobial chemotherapy, 2013-07, Vol.68 (7), p.1660-1668</ispartof><rights>Copyright Oxford Publishing Limited(England) Jul 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-d5900856843cf8ec440438fbc7d6f8902a5f798543994460b06f81a90dc696163</citedby><cites>FETCH-LOGICAL-c384t-d5900856843cf8ec440438fbc7d6f8902a5f798543994460b06f81a90dc696163</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23543609$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Guo, Fengmei</creatorcontrib><creatorcontrib>Yang, Yi</creatorcontrib><creatorcontrib>Kang, Yan</creatorcontrib><creatorcontrib>Zang, Bin</creatorcontrib><creatorcontrib>Cui, Wei</creatorcontrib><creatorcontrib>Qin, Bingyu</creatorcontrib><creatorcontrib>Qin, Yingzhi</creatorcontrib><creatorcontrib>Fang, Qiang</creatorcontrib><creatorcontrib>Qin, Tiehe</creatorcontrib><creatorcontrib>Jiang, Dongpo</creatorcontrib><creatorcontrib>Li, Weiqin</creatorcontrib><creatorcontrib>Gu, Qin</creatorcontrib><creatorcontrib>Zhao, Hongsheng</creatorcontrib><creatorcontrib>Liu, Dawei</creatorcontrib><creatorcontrib>Guan, Xiangdong</creatorcontrib><creatorcontrib>Li, Jianguo</creatorcontrib><creatorcontrib>Ma, Xiaochun</creatorcontrib><creatorcontrib>Yu, Kaijiang</creatorcontrib><creatorcontrib>Chan, Dechang</creatorcontrib><creatorcontrib>Yan, Jing</creatorcontrib><creatorcontrib>Tang, Yaoqing</creatorcontrib><creatorcontrib>Liu, Wei</creatorcontrib><creatorcontrib>Li, Ruoyu</creatorcontrib><creatorcontrib>Qiu, Haibo</creatorcontrib><creatorcontrib>China-SCAN Team</creatorcontrib><creatorcontrib>on behalf of the China-SCAN Team</creatorcontrib><title>Invasive candidiasis in intensive care units in China: a multicentre prospective observational study</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>To describe the epidemiology, microbiology and management of invasive Candida infection (ICI) in intensive care units (ICUs) in China.
A multicentre, prospective, observational study in 67 hospital ICUs across China. Patients were ≥18 years old with clinical signs of infection and at least one of the following diagnostic criteria: (i) histopathological, cytopathological or microscopic confirmation of yeast cells from a normally sterile site; (ii) at least one peripheral blood culture positive for Candida; and (iii) positive Candida culture from a normally sterile site. The China-SCAN study is registered with ClinicalTrials.gov (NCT T01253954).
ICI incidence was 0.32% (306 patients/96,060 ICU admissions) and median time between ICU admission and diagnosis was 10.0 days. Candida albicans was the most prevalent single isolate (41.8% of patients), although non-albicans species accounted for the majority of infections. Diagnostic confirmation was based solely on at least one positive blood culture in 290 (94.8%) cases. Treatment was initiated after diagnostic confirmation in 166/268 (61.9%) patients. Triazoles (62.7%) and echinocandins (34.2%) were the most commonly used antifungal agents; first-line therapy was typically fluconazole (37.7%). The median duration of antifungal therapy was 14 days. The mortality rate was 36.6% (112/306); the median time between diagnosis and death was 14.5 days. Mortality was higher in older individuals, those with solid tumours, those with recent invasive mechanical ventilation and those with a higher sequential organ failure assessment score at diagnostic confirmation. Susceptibility to first-line antifungals was associated with lower mortality than dose-dependent susceptibility or complete resistance (P=0.008).
More infections were caused by non-albicans than Candida albicans strains. The majority of patients were treated only after diagnostic confirmation, rather than empirically. First-line antifungal susceptibility was associated with lower mortality.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Blood - microbiology</subject><subject>Candida - classification</subject><subject>Candida - isolation & purification</subject><subject>Candida albicans</subject><subject>Candidiasis, Invasive - epidemiology</subject><subject>Candidiasis, Invasive - microbiology</subject><subject>Cell culture</subject><subject>China - epidemiology</subject><subject>Disease management</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fungal infections</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive care</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Microbiology</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1LAzEQhoMoWqsXf4AseBFh7WSTzSbepPgFghc9L2mSxdRttm6yhf57p7Z68CQJhMw8M7wzLyFnFK4pKDaZazOxHwkk2yMjygXkBSi6T0bAoMwrXrIjchzjHABEKeQhOSpYyZkANSL2Kax09CuXGR2stx4_MfMBb3Jhl-hdNgSfvuPTdx_0TaazxdAmb1xImF32XVw6kzZ4N4uuX-nku6DbLKbBrk_IQaPb6E5375i83d-9Th_z55eHp-ntc26Y5Cm3pQKQqJAz00hnOAfOZDMzlRWNVFDosqmUROlKcRxzBhimWoE1Qgkq2Jhcbvuins_BxVQvfDSubXVw3RBrioWqwOXwf6BCFYxVVCJ68Qedd0OPw22oCgrOSjxjcrWlDO4i9q6pl71f6H5dU6g3NtVoU721CeHzXcthtnD2F_3xhX0BAimNiQ</recordid><startdate>201307</startdate><enddate>201307</enddate><creator>Guo, Fengmei</creator><creator>Yang, Yi</creator><creator>Kang, Yan</creator><creator>Zang, Bin</creator><creator>Cui, Wei</creator><creator>Qin, Bingyu</creator><creator>Qin, Yingzhi</creator><creator>Fang, Qiang</creator><creator>Qin, Tiehe</creator><creator>Jiang, Dongpo</creator><creator>Li, Weiqin</creator><creator>Gu, Qin</creator><creator>Zhao, Hongsheng</creator><creator>Liu, Dawei</creator><creator>Guan, Xiangdong</creator><creator>Li, Jianguo</creator><creator>Ma, Xiaochun</creator><creator>Yu, Kaijiang</creator><creator>Chan, Dechang</creator><creator>Yan, Jing</creator><creator>Tang, Yaoqing</creator><creator>Liu, Wei</creator><creator>Li, Ruoyu</creator><creator>Qiu, Haibo</creator><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201307</creationdate><title>Invasive candidiasis in intensive care units in China: a multicentre prospective observational study</title><author>Guo, Fengmei ; Yang, Yi ; Kang, Yan ; Zang, Bin ; Cui, Wei ; Qin, Bingyu ; Qin, Yingzhi ; Fang, Qiang ; Qin, Tiehe ; Jiang, Dongpo ; Li, Weiqin ; Gu, Qin ; Zhao, Hongsheng ; Liu, Dawei ; Guan, Xiangdong ; Li, Jianguo ; Ma, Xiaochun ; Yu, Kaijiang ; Chan, Dechang ; Yan, Jing ; Tang, Yaoqing ; Liu, Wei ; Li, Ruoyu ; Qiu, Haibo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-d5900856843cf8ec440438fbc7d6f8902a5f798543994460b06f81a90dc696163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Blood - microbiology</topic><topic>Candida - classification</topic><topic>Candida - isolation & purification</topic><topic>Candida albicans</topic><topic>Candidiasis, Invasive - epidemiology</topic><topic>Candidiasis, Invasive - microbiology</topic><topic>Cell culture</topic><topic>China - epidemiology</topic><topic>Disease management</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fungal infections</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive care</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Microbiology</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guo, Fengmei</creatorcontrib><creatorcontrib>Yang, Yi</creatorcontrib><creatorcontrib>Kang, Yan</creatorcontrib><creatorcontrib>Zang, Bin</creatorcontrib><creatorcontrib>Cui, Wei</creatorcontrib><creatorcontrib>Qin, Bingyu</creatorcontrib><creatorcontrib>Qin, Yingzhi</creatorcontrib><creatorcontrib>Fang, Qiang</creatorcontrib><creatorcontrib>Qin, Tiehe</creatorcontrib><creatorcontrib>Jiang, Dongpo</creatorcontrib><creatorcontrib>Li, Weiqin</creatorcontrib><creatorcontrib>Gu, Qin</creatorcontrib><creatorcontrib>Zhao, Hongsheng</creatorcontrib><creatorcontrib>Liu, Dawei</creatorcontrib><creatorcontrib>Guan, Xiangdong</creatorcontrib><creatorcontrib>Li, Jianguo</creatorcontrib><creatorcontrib>Ma, Xiaochun</creatorcontrib><creatorcontrib>Yu, Kaijiang</creatorcontrib><creatorcontrib>Chan, Dechang</creatorcontrib><creatorcontrib>Yan, Jing</creatorcontrib><creatorcontrib>Tang, Yaoqing</creatorcontrib><creatorcontrib>Liu, Wei</creatorcontrib><creatorcontrib>Li, Ruoyu</creatorcontrib><creatorcontrib>Qiu, Haibo</creatorcontrib><creatorcontrib>China-SCAN Team</creatorcontrib><creatorcontrib>on behalf of the China-SCAN Team</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guo, Fengmei</au><au>Yang, Yi</au><au>Kang, Yan</au><au>Zang, Bin</au><au>Cui, Wei</au><au>Qin, Bingyu</au><au>Qin, Yingzhi</au><au>Fang, Qiang</au><au>Qin, Tiehe</au><au>Jiang, Dongpo</au><au>Li, Weiqin</au><au>Gu, Qin</au><au>Zhao, Hongsheng</au><au>Liu, Dawei</au><au>Guan, Xiangdong</au><au>Li, Jianguo</au><au>Ma, Xiaochun</au><au>Yu, Kaijiang</au><au>Chan, Dechang</au><au>Yan, Jing</au><au>Tang, Yaoqing</au><au>Liu, Wei</au><au>Li, Ruoyu</au><au>Qiu, Haibo</au><aucorp>China-SCAN Team</aucorp><aucorp>on behalf of the China-SCAN Team</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Invasive candidiasis in intensive care units in China: a multicentre prospective observational study</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2013-07</date><risdate>2013</risdate><volume>68</volume><issue>7</issue><spage>1660</spage><epage>1668</epage><pages>1660-1668</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><abstract>To describe the epidemiology, microbiology and management of invasive Candida infection (ICI) in intensive care units (ICUs) in China.
A multicentre, prospective, observational study in 67 hospital ICUs across China. Patients were ≥18 years old with clinical signs of infection and at least one of the following diagnostic criteria: (i) histopathological, cytopathological or microscopic confirmation of yeast cells from a normally sterile site; (ii) at least one peripheral blood culture positive for Candida; and (iii) positive Candida culture from a normally sterile site. The China-SCAN study is registered with ClinicalTrials.gov (NCT T01253954).
ICI incidence was 0.32% (306 patients/96,060 ICU admissions) and median time between ICU admission and diagnosis was 10.0 days. Candida albicans was the most prevalent single isolate (41.8% of patients), although non-albicans species accounted for the majority of infections. Diagnostic confirmation was based solely on at least one positive blood culture in 290 (94.8%) cases. Treatment was initiated after diagnostic confirmation in 166/268 (61.9%) patients. Triazoles (62.7%) and echinocandins (34.2%) were the most commonly used antifungal agents; first-line therapy was typically fluconazole (37.7%). The median duration of antifungal therapy was 14 days. The mortality rate was 36.6% (112/306); the median time between diagnosis and death was 14.5 days. Mortality was higher in older individuals, those with solid tumours, those with recent invasive mechanical ventilation and those with a higher sequential organ failure assessment score at diagnostic confirmation. Susceptibility to first-line antifungals was associated with lower mortality than dose-dependent susceptibility or complete resistance (P=0.008).
More infections were caused by non-albicans than Candida albicans strains. The majority of patients were treated only after diagnostic confirmation, rather than empirically. First-line antifungal susceptibility was associated with lower mortality.</abstract><cop>England</cop><pub>Oxford Publishing Limited (England)</pub><pmid>23543609</pmid><doi>10.1093/jac/dkt083</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of antimicrobial chemotherapy, 2013-07, Vol.68 (7), p.1660-1668 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; Free Full-Text Journals in Chemistry |
| subjects | Adult Aged Aged, 80 and over Antifungal Agents - therapeutic use Blood - microbiology Candida - classification Candida - isolation & purification Candida albicans Candidiasis, Invasive - epidemiology Candidiasis, Invasive - microbiology Cell culture China - epidemiology Disease management Epidemiology Female Fungal infections Hospitals Humans Incidence Intensive care Intensive Care Units Male Microbiology Middle Aged Prospective Studies Survival Analysis Treatment Outcome |
| title | Invasive candidiasis in intensive care units in China: a multicentre prospective observational study |
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