Clancy C J, Barchiesi F, Falconi DiFrancesco L, Morris A J, Snydman D R, Yu V L, Scalise G, Nguyen M H
University of Florida College of Medicine and Veterans Administration Medical Center, Gainesville 32610, USA.
Eur J Clin Microbiol Infect Dis. 2000 Aug;19(8):585-92. doi: 10.1007/s100960000335.
The aim of this study was to define the epidemiology and clinical manifestations of late recurrent candidemia. For this purpose, late recurrent candidemia was defined as an episode of candidemia occurring at least 1 month after the apparent complete resolution of an infectious episode caused by the same Candida sp. A total of five patients with recurrent candidemia were investigated. For all patients, isolates from the initial and recurrent episodes of candidemia were available for in vitro susceptibility testing and genetic characterization by DNA-based techniques. The results revealed the following salient features: prolonged duration between the initial and recurrent episodes (range, 1-8 months); recurrence of candidemia despite anti-fungal therapy; importance of retained intravascular catheters, neutropenia, and corticosteroids as factors predisposing to recurrence; high morbidity and mortality; no emergence of antifungal drug resistance between the initial and recurrent episodes; and relapse of infection due to the original infecting strain, rather than reinfection with a new strain. These findings raise several issues about the management and follow-up of patients with candidemia, which require assessment in future studies.
本研究的目的是明确晚期复发性念珠菌血症的流行病学特征和临床表现。为此，晚期复发性念珠菌血症被定义为在由同一念珠菌属引起的感染性疾病明显完全缓解至少1个月后发生的念珠菌血症发作。共调查了5例复发性念珠菌血症患者。对于所有患者，可获得念珠菌血症初始发作和复发发作的分离株，用于体外药敏试验和基于DNA技术的基因特征分析。结果显示出以下显著特征：初始发作和复发发作之间的间隔时间延长（范围为1 - 8个月）；尽管进行了抗真菌治疗，念珠菌血症仍复发；留置血管内导管、中性粒细胞减少和使用皮质类固醇作为易复发因素的重要性；高发病率和死亡率；初始发作和复发发作之间未出现抗真菌药物耐药性；以及感染复发是由于原始感染菌株，而非新菌株的再次感染。这些发现引发了关于念珠菌血症患者管理和随访的若干问题，需要在未来研究中进行评估。
