Epidemiology, antifungal susceptibilities, and risk factors for invasive candidiasis from 2011 to 2013 in a teaching hospital in southwest China

BackgroundInvasive candidiasis (IC) is the most common cause of invasive fungal infections. Identification of risk factors for such infection may help in the empirical therapeutic decision-making process. We conducted this study to characterize the clinical epidemiology of such infection and to differentiate risk factors between Candida albicans and Candida non-albicans species.MethodsWe retrospectively evaluated patients with IC from 2011 to 2013. Clinical data, antibiotic therapy, underlying condition, and invasive procedures were analyzed and compared between C. albicans and C. non-albicans species.ResultsC. albicans was the most frequently isolated Candida species (48.6% of all IC patients), although C. non-albicans spp. were more commonly isolated overall. C. albicans, Candida tropicalis, and Candida parapsilosis have a high susceptibility rate to all antifungal agents (>90%), whereas Candida glabrata showed decreased susceptibility to fluconazole and itraconazole. Amphotericin B demonstrated excellent antifungal activity against all Candida species. Univariate analyses showed that IC patients with C. albicans had a higher ratio of older age (p = 0.008), solid tumor (p = 0.029), and hypoproteinemia (p = 0.019), whereas those with C. non-albicans spp. had a higher ratio of hospital length of stay (p = 0.005), usage of corticosteroids (p = 0.011), duration on corticosteroids (p = 0.005), chemotherapy (p = 0.022), hematologic malignancy (p = 0.039), neutropenia (p = 0.030), and usage of glycopeptides (p = 0.002). Multivariate analyses showed that a significant predictor of IC due to C. albicans was hypoproteinemia [odds ratio (95% confidence interval) = 2.133 (1.164-3.908), p = 0.014].ConclusionC. albicans was the most frequently isolated Candida species. The risk factors between C. albicans and C. non-albicans species are different.