Evaluation of the guidelines for infection control and prevention, which was made for national university hospitals in Japan

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In a 1 year national-wide surveillance program, 535 Candida blood isolates were collected. The overall species distribution was: 41% Candida albicans, 23% Candida parapsilosis, 18% Candida grabrata, 12% Candida tropicalis and 2% Candida krusei. Percentage of fluconazole resistance were 7.8% for all isolates, while, newer agents, voriconazole and micafangin, were both more active than fluconazole for almost all species. Univariate analysis of the demographic and clinical factors associated with fluconazole resistance revealed that age, hematologic malignancy, neutropenia, and immunosuppression were of statistical significance. A multiple logistic regression model showed that only hematologic malignancy as the underlying disease (odds ratio, 6.6; 95% confidence interval, 1.6-26.9; P=0.009) was independently associated with resistance. In 242 cases in which data regarding management and prognosis were available, the 30-day survival rate was 68.4%. In the univariate analysis of factors predicting survival, a significant association was found for Candida species, age of the patient, neutropenia, recent abdominal surgery, removal of the central venous catheter, and use of appropriate antifungal therapy. In the multivariate analysis, removal of the central venous catheter (odds ratio, 6.0; 95% confidence interval, 2.2-16.1; P<0.001) and the use of appropriate therapy (odds ratio, 2.1; 95% confidence interval, 1.1-4.1; P=0.03) were independent factors significantly associated with survival after the diagnosis of Candida bloodstream infection. This work is the first nationwide, large-scale surveillance study conducted in Japan to obtain microbiological and clinical data of Candida bloodstream infection. The data obtained in this study would be indispensable for making clinical guideline for Candida bloodstream infection in Japan.