目的: Candida spp. are important causes of bloodstream infections (BSI), responsible for significant mortality and morbidity among hospitalized patients. Increasing use of antifungal treatment in ICU did not result decreasing mortality in decades. 
 

方法: From January 2008 to December 2015, all consecutive patients who developed Candida BSI at Ruijin University Hospital were enrolled. Underlying diseases, clinical severity, species distribution, appropriate or delayed antifungal therapy and those impact on the 30-day mortality were analyzed.

结果: A total of 230 consecutive episodes of Candida BSI were collected, occurred in 222 inpatients, during 8-year study period with an incidence of 0.35 episodes/1000 admissions, which has increased steadily in the first 5 years (0.21, 0.23, 0.26, 0.44 and 4.11 episodes per 1,000 admissions from 2008 to 2012), and was stable in the next 3 years (0.34 in 2013, 0.40 in 2014 and 0.46 in 2015).
A total 233 Candida species were isolated from 230 episodes of BSI. Eighty-seven (37.3%) of Candida BSI were C. albicans, followed by C. parapsilosis (43, 18.5%), C. tropicalis (36, 15.5%) and C. glabrata (30, 15.5%).
The overall, 30-day mortality rate was 30.0%. Mortality was significantly higher for those who did not receive any antifungal therapy compared with those who received antifungal therapy (P=0.08, 45.1% vs. 25.7%). There was no significant difference in mortality between appropriate therapy group and delayed therapy group (26.1% vs. 22.2%, P=0.943).
In multivariate Cox regression analysis, advanced age (OR=1.022; 95%CI, 1.009-1.036; P=0.003), chronic renal failure (OR=2.135; 95%CI, 1.203-3.790; P=0.01), neutropenia (OR=5.726; 95%CI 2.796-11.728; P<0.001), more than 3 categories antibiotic exposure (OR= 2.589; 95%CI, 1.531-4.379; P<0.001) were independent risk factor for 30-day mortality, while infected with C. non-albicans (OR= 0.390; 95%CI, 0.231-0.659; P<0.001) and appropriate antifungal therapy (OR=0.466; 95%CI, 0.283-0.753; P=0.003) remained independent protective factors for 30-day mortality.

结论: Appropriate antifungal therapy did influence the short-term survival of patients with Candida BSI while delayed antifungal therapy may also improve the mortality. A control program might be developed to avoid antifungal agent abuse for unnecessary empiric indication. It could be done with the help of an antimicrobial stewardship team.