[Clinical characteristics and influencing factors of nosocomial candidemia].

Objective: To retrospectively explore the clinical features and risk factors of nosocomially acquired candidemia.

Methods: Retrospective analyses were conducted for general information, underlying diseases, risk factors, clinical features and laboratory tests of blood culture Candida-positive cases at Beijing Hospital from January 1, 2006 to December 31, 2011. Comparisons were made with regards to the clinical features, prognostic factors, risk factors of candidemia pathogen distribution between dead and survival groups and Candida albicans vs non-Candida albicans groups. Statistical analysis was performed with SPSS 19.0.

Results: A total of 30 Candida albicans and 35 non-candida albicans cases were recruited. Their mean age was (76±14) years and total in-hospital fatality rate 58.5% (38/65). The acute physiology and chronic health evaluation II (APACHE II) score, ratio of APACHE II score>24 points, ratio of shock, primary diagnosis time (from onset to reporting time of positive outcome of blood culture) and ratio of serum albumin≤30 g/L of death group were (28.7±8.6) score, 55.3% (21/38), 71.1% (27/38), (138.7±50.4) h, 47.4% (18/38) respectively. And the values were significantly higher than those of survival group, i.e. (20.1±8.0) score, 29.6% (8/27), 44.4% (12/27), (127.2±50.2) h and 22.2% (6/27) respectively. Multivariate Logistic regression analysis showed that shock (OR=4.821, P=0.030), primary diagnosis time (OR=1.594, P=0.027) and APACHE II score (OR=1.096, P=0.032) were independent risk factors for death. However continuous blood purification therapy was an independent protective factor (OR=0.014, P=0.004). And diabetes was an independent risk factors for non-Candida albicans infection (OR=4.426, P=0.016).

Conclusions: Advanced age, more underlying diseases, severe clinical conditions and high fatality rate are the major clinical characteristics of candidemia. Shock, APACHE II score and primary diagnosis time are independent risk factors for death. Continuous blood purification therapy is a protective factor. And diabetes is an independent risk factor for non-Candida albicans candidemia.