Xianlian Chen-Data

Candidemia poses a substantial global health threat due to its high mortality. This study analyzed 133 candidemia cases from a tertiary hospital in Guizhou, China, to assess clinical characteristics, species distribution, antifungal susceptibility, and molecular epidemiology. Non-albicans Candida (NAC) species predominated (52.6%) over C. albicans (47.4%), with an overall 30-day mortality of 48.1%. C. albicans-infected patients had higher mortality, where hypoalbuminemia and septic shock were independent risk factors, while antifungal therapy and higher platelet counts were protective. In NAC infections, septic shock and elevated serum urea predicted mortality. Prognostic biomarkers differed: D-dimer and C-reactive protein for C. albicans, versus urea and total bilirubin for NAC. Most isolates remained susceptible to antifungals, but C. glabrata and C. tropicalis exhibited increased azole resistance. Multilocus sequence typing of 48 C. albicans isolates identified 37 genotypes (62.2% novel), with two novel clonal complexes (CC138and CC139) forming a distinct Chinese cluster. These findings enhance understanding of candidemia management, resistance patterns, and molecular epidemiology, aiding in optimized treatment and infection control strategies.

念珠菌血症（Candidemia）因其高死亡率对全球健康构成重大威胁。本研究分析了中国贵州某三级医院的133例念珠菌血症病例，旨在评估其临床特征、菌种分布、抗真菌药敏性（antifungal susceptibility）及分子流行病学（molecular epidemiology）特征。非白念珠菌（Non-albicans Candida, NAC）菌种占主导地位（52.6%），高于白念珠菌（C. albicans）（47.4%），总体30天死亡率为48.1%。白念珠菌感染患者死亡率更高，其中低白蛋白血症（hypoalbuminemia）和感染性休克（septic shock）为独立危险因素，而抗真菌治疗和较高的血小板计数为保护因素。在非白念珠菌感染中，感染性休克和血清尿素（serum urea）升高是死亡的预测因素。预后生物标志物存在差异：白念珠菌感染为D-二聚体（D-dimer）和C反应蛋白（C-reactive protein），非白念珠菌感染则为尿素和总胆红素（total bilirubin）。大多数分离株对真菌仍敏感，但光滑念珠菌（C. glabrata）和热带念珠菌（C. tropicalis）表现出更高的唑类耐药性（azole resistance）。对48株白念珠菌分离株进行多位点序列分型（Multilocus sequence typing），鉴定出37种基因型（其中62.2%为新型），且两个新型克隆复合体（clonal complexes, CC138和CC139）形成了独特的中国聚类群。这些发现加深了对念珠菌血症管理、耐药模式及分子流行病学的理解，有助于优化治疗和感染控制策略。