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Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes

Overview of attention for article published in Antimicrobial Resistance & Infection Control, March 2017
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Title
Candidemia in a major regional tertiary referral hospital – epidemiology, practice patterns and outcomes
Published in
Antimicrobial Resistance & Infection Control, March 2017
DOI 10.1186/s13756-017-0184-1
Pubmed ID
Authors

Jocelyn Qi-Min Teo, Samuel Rocky Candra, Shannon Jing-Yi Lee, Shannon Yu-Hng Chia, Hui Leck, Ai-Ling Tan, Hui-Peng Neo, Kenneth Wei-Liang Leow, Yiying Cai, Rachel Pui-Lai Ee, Tze-Peng Lim, Winnie Lee, Andrea Lay-Hoon Kwa

Abstract

Candidemia is a common cause of nosocomial bloodstream infections, resulting in high morbidity and mortality. This study was conducted to describe the epidemiology, species distribution, antifungal susceptibility patterns and outcomes of candidemia in a large regional tertiary referral hospital. A retrospective surveillance study of patients with candidemia was conducted at Singapore General Hospital between July 2012 and December 2015. In addition, incidence densities and species distribution of candidemia episodes were analysed from 2008 to 2015. In the period of 2012 to 2015, 261 candidemia episodes were identified. The overall incidence was 0.14/1000 inpatient-days. C. glabrata (31.4%), C. tropicalis (29.9%), and C. albicans (23.8%) were most commonly isolated. The incidence of C. glabrata significantly increased from 2008 to 2015 (Coefficient 0.004, confidence interval 0-0.007, p = 0.04). Fluconazole resistance was detected primarily in C. tropicalis (16.7%) and C. glabrata (7.2%). fks mutations were identified in one C. albicans and one C. tropicalis. Candidemia episodes caused by C. tropicalis were more commonly encountered in patients with haematological malignancies (p = 0.01), neutropenia (p < 0.001) and higher SAPS II scores (p = 0.02), while prior exposure to echinocandins was associated with isolation of C. parapsilosis (p = 0.001). Echinocandins (73.3%) were most commonly prescribed as initial treatment. The median (range) time to initial treatment was 1 (0-9) days. The 30-day in-hospital mortality rate was 49.8%. High SAPS II score (Odds ratio, OR 1.08; 95% confidence interval, CI 1.05-1.11) and renal replacement therapy (OR 5.54; CI 2.80-10.97) were independent predictors of mortality, while drain placement (OR 0.44; CI 0.19-0.99) was protective. Decreasing azole susceptibilities to C. tropicalis and the emergence of echinocandin resistance suggest that susceptibility patterns may no longer be sufficiently predicted by speciation in our institution. Candidemia is associated with poor outcomes. Strategies optimising antifungal therapy, especially in the critically-ill population, should be explored.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 78 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 78 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 13 17%
Student > Ph. D. Student 9 12%
Researcher 7 9%
Student > Doctoral Student 5 6%
Student > Bachelor 5 6%
Other 19 24%
Unknown 20 26%
Readers by discipline Count As %
Medicine and Dentistry 20 26%
Agricultural and Biological Sciences 10 13%
Nursing and Health Professions 6 8%
Biochemistry, Genetics and Molecular Biology 5 6%
Immunology and Microbiology 5 6%
Other 8 10%
Unknown 24 31%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 March 2017.
All research outputs
#19,512,854
of 24,003,070 outputs
Outputs from Antimicrobial Resistance & Infection Control
#1,200
of 1,347 outputs
Outputs of similar age
#240,035
of 311,306 outputs
Outputs of similar age from Antimicrobial Resistance & Infection Control
#22
of 23 outputs
Altmetric has tracked 24,003,070 research outputs across all sources so far. This one is in the 10th percentile – i.e., 10% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,347 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 15.6. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 311,306 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 12th percentile – i.e., 12% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 23 others from the same source and published within six weeks on either side of this one. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.