Introduction: Fungal infection is increasingly common in critical illness with severe sepsis, but the influence of invasive fungal infection (IFI) on severe sepsis is not well understood. The aim of this study was to investigate the impact that IFI has on the outcomes of critically ill surgical patients with severe sepsis in China by means of matched cohort analysis; we also evaluated the epidemiologic characteristics of IFI in this population. Methods: Records for all admissions to 10 university hospital surgical intensive care units (ICUs) from December 2004 to November 2005 were reviewed. Patients who met criteria for severe sepsis were included. IFI was identified using established criteria based on microbiologic or histological evidence. A matched cohort study was conducted to analyze the relationship between IFI and outcomes of severe sepsis. Results: A total of 318 patients with severe sepsis were enrolled during the study period, of whom 90 (28.3%) were identified as having IFI. A total of 100 strains of fungi (58% Candida albicans) were isolated from these patients. Independent risk factors for IFI in patients with severe sepsis included mechanical ventilation (>3 days), Acute Physiology and Chronic Health Evaluation score, coexisting infection with both Gram-positive and Gram-negative bacteria, and urethral catheterization (>3 days). Compared with the control cohort, IFI was associated with increased hospital mortality (P < 0.001), high hospital costs (P = 0.038), and prolonged stay in the ICU (P < 0.001) and hospital (P = 0.020). Conclusion: IFI is frequent in patients with severe sepsis in surgical ICUs and is associated with excess risk for hospital mortality, longer ICU and hospital stays, and greater consumption of medical resources.

Background: The incidence and mortality of esophageal cancer are high. Therefore, we aimed to investigate how the number of dissected lymph nodes during esophagectomy for esophageal squamous cell carcinoma impacts overall survival, particularly that of patients with positive lymph nodes. Materials and methods: Data from 2010 to 2017 were obtained from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database. Participants were divided into two groups: patients with negative lymph nodes (N0) and patients with positive lymph nodes (N+). The median number of resected lymph nodes during surgery was 24; therefore, patients with 15 to 23 and those with 24 or more resected lymph nodes were assigned to subgroups A and B, respectively. Results: After a median follow-up of 60.33 months, 1,624 patients who underwent esophagectomy were evaluated; 60.53% and 39.47% had a pathological diagnosis of N+ or N0, respectively. The median overall survival was 33.9 months for the N+ group; however, the N0 group did not achieve the median overall survival. The mean overall survival was 84.9 months. In the N+ group, the median overall survival times of subgroups A and B were 31.2 and 37.1 months, respectively. The overall survival rates at 1, 3, and 5 years were 82%, 43%, and 34%, respectively, for subgroup A of the N+ group; they were 86%, 51%, and 38%, respectively, for subgroup B of the N+ group. Subgroups A and B of the N0 group exhibited no statistically significant differences. Conclusion: Increasing the number of lymph nodes harvested during surgery to 24 or more could improve the overall survival of patients with positive lymph nodes but not that of patients with negative lymph nodes. Export

In patients hospitalized in intensive care units (ICU), Candida infections are associated with increased morbidity, mortality and costs. However, previous studies reported confused risk factors for catheter-related Candida bloodstream infection (CRCBSI). The objective was to describe the risk factors, microbiology, management and outcomes of CRCBSI in the China-SCAN population. Patients with ≥1 Candida-positive peripheral blood culture were selected from the China-SCAN study. Peripheral and catheter blood samples were collected for Candida isolation. Patients with the same strain of Candida in peripheral and catheter blood samples were considered as being with CRCBSI, while patients with Candida-positive peripheral blood cultures only or different strains were considered as non-CRCBSI. Data were collected from the China-SCAN study. CRCBSI incidence in ICU was 0.03% (29/96,060), accounting for 9.86% of all candidemia observed in ICU (29/294). The proportion of CRCBSI due to Candida parapsilosis reached 33.3%, more than that of Candida albicans (28.6%). In univariate analyses, older age (P = 0.028) and lower body weight (P = 0.037) were associated with CRCBSI. Multivariate analysis showed that the sequential organ failure assessment (SOFA) score was independently associated with CRCBSI (odds ratio (OR) = 1.142, 95% confidence interval = 1.049-1.244, P = 0.002). Catheter removal and immune enhancement therapy were often used for CRCBSI treatment. In China, CRCBSI was more likely to occur in old patients with low body weight. SOFA score was independently associated with CRCBSI. Candida parapsilosis accounted for a high proportion of CRCBSI, but the difference from non-CRCBSI was not significant.

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