Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

PLoS One. 2016 Oct 31;11(10):e0165346. doi: 10.1371/journal.pone.0165346. eCollection 2016.


Background: Candidemia is an important cause of mortality in healthcare settings. Peripheral lines are a source of candidemia, yet few studies have reported on the clinico-epidemiological features of candidemia due to peripheral-line associated blood stream infection (PLABSI).

Methods: We conducted a single-centre retrospective cohort study of all patients with candidemia between 2002 and 2013. PLABSI was defined as the presence of at least one of the following: the presence of phlebitis or the resolution of clinical symptoms after peripheral-line withdrawal, with careful exclusion of an alternative explanation for bacteraemia. We described the epidemiology of candidemia and assessed predictive factors of PLABSI due to Candida spp., peripheral line-associated candidemia (PLAC), compared with non-PLAC.

Results: A total of 301 episodes of candidemia, including 37 of PLAC, were diagnosed during the study period. Central-line associated blood stream infection, intra-abdominal infection, and infection of unknown source accounted for the remaining 233, 14, and 17 cases, respectively. The overall incidence rate of candidemia was 0.11/1000 patient-days. In multivariate analysis, cephalosporin exposure (odds ratio [OR] = 2.22, 95% CI 1.04-4.77), polymicrobial bacteraemia/fungaemia (OR = 2.87, 95% CI 1.02-8.10), and ID specialist consultation (OR = 2.40, 95% CI 1.13-5.13) were identified as independent predictors of PLAC. Although non-PLAC had a higher mortality, the length of hospital stay after candidemia was similar between the two groups and candidemia duration was longer in the PLAC group.

Conclusion: PLACs are an important cause of candidemia in hospitalized patients. Appropriate identification and management of PLAC are crucial.

MeSH terms

  • Aged
  • Candida / isolation & purification
  • Candida / physiology*
  • Candidemia / blood*
  • Candidemia / epidemiology*
  • Candidemia / microbiology
  • Humans
  • Japan
  • Multivariate Analysis
  • Retrospective Studies
  • Tertiary Care Centers / statistics & numerical data*

Grant support

This study was funded by Grants for International Health Research (28S-1106) from the Ministry of Health, Labor, and Welfare of Japan and by Grants for International Medical Cooperation (26S-101) from the National Center for Global Health and Medicine. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.