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. 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. 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. 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.

中文翻译：

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医院内念珠菌属的流行病学、物种分布和结果。上海血流感染：某三级甲等医院11年回顾性分析

念珠菌血流感染 (BSI) 的发病率随着时间的推移而增加。在本研究中，我们旨在描述上海一家大型三级医院中念珠菌 BSI 的当前流行病学，并确定 28 天死亡率的危险因素和抗真菌治疗对临床结果的影响。纳入2008年1月1日至2018年12月31日在瑞金医院连续住院的念珠菌BSI成人患者。分析了潜在疾病、临床严重程度、物种分布、抗真菌治疗及其对结果的影响。在连续发生393次念珠菌BSI的370例住院患者中，院内念珠菌BSI的发生率为0.39次/1000名住院患者。在 393 例中，299 例（76. 1%) 接受了抗真菌治疗（分别有 247 和 52 人接受了早期适当和靶向抗真菌治疗）。总体 28 天死亡率为 28.5%，接受早期适当 (25.5%) 或靶向 (23.1%) 抗真菌治疗的患者显着低于未接受抗真菌治疗的患者 (39.4%；P = 0.012 和 P = 0.046) ， 分别）。在多变量 Cox 回归分析中，发现年龄、慢性肾功能衰竭、机械通气和严重的中性粒细胞减少是 28 天死亡率的独立危险因素。接受抗真菌治疗的患者的死亡风险低于未接受抗真菌治疗的患者。在我们上海的三级医院，念珠菌 BSI 的发病率在过去 11 年中稳步上升。抗真菌治疗影响短期生存，