Epidemiology, Species Distribution, and Outcome of Nosocomial Candida spp. Bloodstream Infection in Shanghai — An 11-year Retrospective Analysis in a Tertiary Care Hospital

Abstract BackgroundThe incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. MethodsAll consecutive adult inpatients with Candida BSI at Ruijin Hospital from 2008.1 to 2018.12 were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. ResultsAmong the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P=0.012 and P=0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and neutropenia were found to be independent risk factors of 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not.ConclusionsThe incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between those who received early appropriate and targeted antifungal therapy.

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Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-021-00441-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Yan-Jun Zheng ◽

Ting Xie ◽

Lin Wu ◽

Xiao-Ying Liu ◽

Ling Zhu ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Antifungal Therapy ◽

Species Distribution ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Clinical Severity ◽

Severe Neutropenia ◽

Care Hospital ◽

The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

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Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai — An 11-year retrospective analysis in a tertiary care hospital

10.21203/rs.3.rs-212048/v2 ◽

2021 ◽

Author(s):

Yanjun Zheng ◽

Ting Xie ◽

Lin Wu ◽

Xiaoying Liu ◽

Ling Zhu ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Antifungal Therapy ◽

Species Distribution ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Clinical Severity ◽

Severe Neutropenia ◽

Care Hospital ◽

The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008 and December 31, 2018 were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P=0.012 and P=0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not.Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

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Epidemiology, species distribution and outcome of nosocomial Candida spp. bloodstream infection in Shanghai — A retrospective of 11-year clinical analysis in a shanghai tertiary hospital

10.21203/rs.2.24729/v1 ◽

2020 ◽

Author(s):

yanjun Zheng ◽

xie Ting ◽

lin Wu ◽

xiaoying Liu ◽

ling Zhu ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Antifungal Therapy ◽

Species Distribution ◽

Clinical Severity ◽

Care Hospital ◽

Short Term ◽

Candida Spp ◽

Term Survival ◽

Short Term Survival

Abstract Background: Candida spp. are important opportunist pathogens causing bloodstream infections (BSIs). The present study aims to describe the current epidemiology of Candida BSI in a large Shanghai Tertiary-care Hospital from 2008 to 2018, and to identify the risk factors and the impact of antifungal therapy on clinical outcome.Methods: From January 2008 to December 2018, all consecutive patients who developed Candida BSI at Ruijin Hospital were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy and its impact on the outcome were analyzed.Results: The incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients, and overall 30-day mortality rate was 28.5%. Among the 393 cases of Candida BSI, 299 cases (76.1%) received antifungal therapy. 247 received appropriate antifungal therapy, and 52 received delayed antifungal therapy (5 days after onset of Candida BSI). The 30-day mortality rate was significantly lower in those who received appropriate antifungal therapy or delayed antifungal therapy compared with those who did not receive antifungal therapy (25.5% and 23.1% vs. 39.4%，P=0.012 and P=0.046). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, neutropenia were independent risk factors for the 30-day mortality rate, while antifungal therapy was a protective factor for short-term survival rate.Conclusion: The epidemiology of Candida BSI in Shanghai differed from that observed in Western countries. Antifungal therapy did influence the short-term survival, while there was no significant difference between the mortality for those who received appropriate antifungal therapy and for those who received delayed antifungal therapy.

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Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai — A retrospective of 11-year clinical analysis in a shanghai tertiary hospital

10.21203/rs.3.rs-63464/v1 ◽

2020 ◽

Author(s):

Yan-Jun ZHENG ◽

Ting XIE ◽

Lin WU ◽

Xiao-Ying LIU ◽

Ling ZHU ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Antifungal Therapy ◽

Species Distribution ◽

Clinical Severity ◽

Care Hospital ◽

Short Term ◽

Candida Spp ◽

Term Survival ◽

Short Term Survival

Abstract Background: Candida spp. are important opportunist pathogens causing bloodstream infections (BSIs). The present study aims to describe the current epidemiology of Candida BSI in a large Shanghai Tertiary-care Hospital from 2008 to 2018 and to identify the risk factors and the impact of antifungal therapy on clinical outcomes. Methods: From January 2008 to December 2018, all consecutive patients who developed Candida BSI at Ruijin Hospital were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and its impact on the outcome were analyzed. Results: The incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients, and the overall 28-day mortality rate was 28.5%. Among the 393 cases of Candida BSI, 299 cases (76.1%) received antifungal therapy. 247 received early appropriate antifungal therapy (an appropriate drug with adequate dosage was started before the subsequent in vitro susceptibility results), and 52 received target antifungal therapy (appropriate target treatment started after susceptibility results, regardless of whether the inappropriate antifungal treatment has been initialed or not). The 28-day mortality rate was significantly lower in those who received early appropriate antifungal therapy or target antifungal therapy compared with those who did not receive antifungal therapy (25.5% and 23.1% vs. 39.4%,P = 0.012 and P = 0.046). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, neutropenia were independent risk factors for the 28-day mortality rate, while antifungal therapy was a protective factor for short-term survival rate. Conclusions: The epidemiology of Candida BSI in Shanghai differed from that observed in Western countries. Antifungal therapy did influence the short-term survival, while there was no significant difference between the mortality for those who received early appropriate antifungal therapy and for those who received target antifungal therapy.

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Clinical Symptoms, Pathogen Spectrum, Risk Factors and Antibiogram of Suspected Neonatal Sepsis Cases in Tertiary Care Hospital of Southern Part of Nepal: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5094 ◽

2020 ◽

Vol 58 (232) ◽

Author(s):

Bijay Raj Pandit ◽

Ashish Vyas

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Neonatal Sepsis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Neonatal Mortality Rate ◽

Cross Sectional

Introduction: Neonatal mortality rate is highest in sub-Saharan Africa and Southern Asia region. The present study is undertaken to find out prevalence of neonatal sepsis, recognize bacterial pathogens, neonatal risk factors, major symptoms, and their antibiotic sensitivity pattern in neonates in tertiary care hospital in southern Nepal. Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital from 2nd January 2017 to 20th February 2018 after approval (Ref: 125/2016-17). The sample size was calculated and convenience sampling was done. Data were collected from hospital records and microbiology laboratory and analyzed by Statistical Package for Social Sciences. Results: Out of 1200 clinically suspected cases, early-onset neonatal sepsis was seen in 290 (79.89%). A positive culture was seen in 363 (30.25%) where maximum bacterial growth was found in 254 (69.98%) males. Preterm gestational age was seen in 265 (73%), low birth weight 284 (78.23%), a vaginal delivery mode in 279 (76.90%), and delivery in hospital in 232 (63.91%). Likewise, Staphylococcus aureus in 229 (63.08%) was found maximum followed by Klebsiella pneumoniae in 48(13.22%). The major symptom observed was Respiratory distress in 245 (20.41%) while culture positive was seen in poor cry in 94 (53.10%). Mainly effective antibiotics against Gram-positive and gram-negative organisms were Linezolid in 250 (94%) and Imipenem in 46 (90.19%), whereas Penicillin-G in 254 (99.21%) and Ampicillin in 38 (94.74%) found resistance towards organisms respectively. Conclusions: The high prevalence of neonatal sepsis in our study reflects a huge challenge to reduce the neonatal mortality rate to 12 by 2030 of Sustainable Development Goals. Bacterial isolates exhibited higher resistance towards commonly used antibiotics.

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1702. Prevalence and Risk Factors for Endogenous Fungal Endophthalmitis in Adult Patients with Candidemia at a Tertiary Care Hospital in South Korea Over 13 years

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1566 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S623-S623

Author(s):

Jong Hun Kim ◽

Jin Woong Suh ◽

You Seung Chung ◽

Young Kyung Yoon ◽

Jang Wook Sohn ◽

...

Keyword(s):

Risk Factors ◽

South Korea ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Adult Patients ◽

Ophthalmological Examination ◽

Care Hospital ◽

Fungal Endophthalmitis ◽

Endogenous Fungal Endophthalmitis ◽

Significant Difference

Abstract Background Endogenous fungal endophthalmitis is one of the critical complications of candidemia in adult patients. We conducted a study to investigate the prevalence and risk factors for endogenous fungal endophthalmitis in adult patients with candidemia. Methods Adult patients ≥19 years with candidemia who underwent ophthalmological examination after the diagnosis of candidemia at a tertiary care hospital in South Korea from 2006 to 2018 were enrolled, and clinical data were collected. Results There was a total of 152 adult patients with candidemia who underwent an ophthalmological examination. Endogenous fungal endophthalmitis was found in 29 patients (19.1%). Patients were categorized into two groups (Non-endophthalmitis [NE] and endophthalmitis [E]). Between two groups, there was no significant difference in terms of age, sex, underlying comorbidities. Also, no difference in clinical conditions at the diagnosis of candidemia was noted including concomitant bacteremia, presence of septic shock, receipt of recent surgery, presence of neutropenia, total parenteral nutrition, central venous catheter, urinary catheter, ventilator, dialysis, use of antibiotics, and Candida spp. colonization. However, there was a higher rate of abnormal alanine aminotransferase (ALT) in the E (35.7%) than in the NE (14.8%), P = 0.008. Moreover, the proportion of C. albicans candidemia was higher in the E (65.5%) than in the NE (35.8%), P = 0.003. In contrast, C. parapsilosis candidemia was more common in the NE (27.6%) than in the E (6.9%), P = 0.018. Although there was a trend of higher mortality rate in the E (51.7%) than in the NE (35.0%), no statistical significance was observed, P = 0.095. Multivariate logistic analysis showed C. albicans candidemia (odds ratio [OR] 4.122, 95% confidence interval [CI] 1.653–10.280, P = 0.002) and abnormal ALT (OR 3.839, 95% CI 1.427–10.333, P = 0.008) were significantly associated with E cases. Conclusion Endogenous fungal endophthalmitis occurred in 19% of adult patients with candidemia. C. albicans candidemia and abnormal ALT were significantly associated with endophthalmitis. Adult patients with candidemia caused by C. albicans or having abnormal ALT need to be closely monitored for the possibility of endophthalmitis. Disclosures All authors: No reported disclosures.

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Impact of Covid-19 Virus on Ophthalmology Residents and Fellows in a Tertiary Care Hospital

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i4.1189 ◽

2021 ◽

Vol 37 (4) ◽

Author(s):

Maryum Nawaz

Keyword(s):

Tertiary Care Hospital ◽

Negative Impact ◽

Clinical Skills ◽

Tertiary Care ◽

Surgical Skills ◽

Care Hospital ◽

Post Graduate ◽

Significant Difference ◽

Graduate Trainees ◽

The Impact

Purpose: To determine the impact of COVID-19 pandemic on the training of Ophthalmology residents and fellows in a tertiary care hospital. Study Design: Cross sectional survey. Place and Duration of Study: The study was conducted in a tertiary care hospital, Peshawar from august 1st to august 20th 2020. Methods: A self-designed questionnaire was distributed among 50 ophthalmology residents and fellows. Under-graduate students, house officers and post-graduate trainees from other specialties were excluded. Questions comprised of demographic data, and questions which were meant to investigate the changes experienced by the trainees during COVID-19. The data was analyzed by SPSS Software (Version 19). Results: Among 50 participants of this study, 16 (32%) were females and 34 (68%) were males. The age ranged from 27 to 35 years. There was no statistically significant difference in the perspectives of resident trainees and fellows regarding negative impact of COVID-19 on their training. Ninety-five percent of the residents and fifty five percent of the fellows had effect on their clinical skills with p values of less than 0.05. Hundred percent residents agreed that online case presentation could not replace the traditional long rounds and simulator based training could improve the surgical skills in pandemic. Twenty five (60.97%) trainees and 6 (66.66%) fellows mentioned that pandemic affected them psychologically and they felt fear while working. Conclusion: COVID-19 has adversely affected the training of post graduate trainees. Training directors should ensure to provide modern technological tools to improve trainees’ clinical and surgical skills until the crisis is over. Key Words: COVID-19, Ophthalmology, Training, Conference.

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All-Cause Mortality after Tracheostomy at a Tertiary Care Hospital over a 10-Month Period

Otolaryngology ◽

10.1177/0194599812437316 ◽

2012 ◽

Vol 146 (6) ◽

pp. 918-922 ◽

Cited By ~ 5

Author(s):

Alexandra E. Kejner ◽

Paul F. Castellanos ◽

Eben L. Rosenthal ◽

Mary T. Hawn

Keyword(s):

Mortality Rate ◽

Length Of Stay ◽

Cause Of Death ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Case Series ◽

Postoperative Mortality ◽

Care Hospital ◽

Icu Patients ◽

Significant Difference

Objective. To evaluate perioperative mortality after tracheostomy in intensive care unit (ICU) patients undergoing routine tracheostomy over a 10-month period. Study Design. Case series with planned data collection. Setting. Tertiary care hospital. Subjects. Mechanically ventilated patients. Methods. Prospective analysis of ICU patients undergoing tracheostomy placement over 10 months was performed. Variables evaluated were demographics, pretracheostomy length of stay, time on ventilator, time to death, preoperative comorbidities, and cause of death. Results. There were 129 consultations resulting in 115 tracheostomies, of which 100 were included for study. The overall 30-day postoperative mortality rate was 25%, including palliative care deaths. Cause of death in all cases was due to a preexisting condition and not from tracheostomy. Patients who died within the 30-day postoperative period were found to have significant differences in age, pretracheostomy length of stay, location of tracheostomy, and preoperative comorbidity scores. No significant difference was found in time on ventilator, sex, or race/ethnicity. Mean time from consultation to tracheostomy was 2.5 days (range, 0-12 days). Conclusion. High rates of mortality after tracheostomy can possibly affect hospital quality ratings for surgical services. There were no deaths directly related to surgery. Despite this, the mortality rate in this population was quite high. This illustrates the significant disease burden in these patients and the need to stratify postoperative mortality as well as to consider comorbidity and age when evaluating patients for tracheostomy.

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