Kappe R, Streitzig S, Böhrer H
Institut für Medizinische Mikrobiologie und Hygiene am Helios Klinikum Erfurt.
Dtsch Med Wochenschr. 2001 Aug 17;126(33):905-8. doi: 10.1055/s-2001-16501.
The early clinical diagnosis of invasive candidiasis is difficult. Fluconazole, which has been available since the early 1990s, is a relatively atoxic intravenously applicable antimycotic agent. For this reason it has been widely used - possibly too much. The aim of this study was the retrospective critical evaluation of the efficacy of systemic antifungal chemotherapy in non-neutropenic, Candida-colonized, surgical patients in long-term intensive care.
69 patients (54 men and 15 women, aged 55.8 [range 18-87] years) of 364 patients of the anaesthesiological intensive care unit (ICU) of the University Hospital of Heidelberg in 1991 and 1992 were selected for the study. None of the 69 patients was suffering from proven invasive candidiasis according to the gold-standard criteria of positive histology, blood culture, or isolation from a sterile compartment. However, 35 of the 69 patients were systemically treated with fluconazole (on average 295 mg per day for 10.2 days intravenously). 34 patients did not receive any antifungal therapy. Retrospectively we analysed the course of the disease in both groups of patients. Furthermore, 173 serum samples of these patients were available for investigations by Western blot for anti-Candida antibodies of the immune globulin classes M and G.
Both groups, antimycotically treated and untreated patients, had similar characteristics at base-line: age, sex, underlying disease, severity of the disease (APACHE II Score), and also mortality (approximately 20 % in both groups). Only times in the ICU and on mechanical ventilation were significantly enhanced in fluconazole treated patients (p values 0.0004 each). Before therapy, the fluconazole patients had significantly more often yeasts in primarily non-sterile compartments (chi (2) test 0.05). The yeasts were partly eradicated by fluconazole (32/54, 59.3 %). Anti-Candida antibodies significantly correlated with higher age (anti 47 kDa antigen, p = 0.02), but not with other, clinically, diagnostically or prognostically relevant parameters.
Fluconazole in non-neutropenic, Candida-colonized, surgical patients in long-term ICU care neither improved the clinical course nor the mortality rate among these patients. These observations indicate that there was a trend of overestimating the clinical significance of Candida in this group of patients. Fluconazole therapy may be significantly reduced in such patients.
侵袭性念珠菌病的早期临床诊断较为困难。氟康唑自20世纪90年代初开始应用，是一种相对低毒的静脉用抗真菌药物。因此，它已被广泛使用——可能使用过度了。本研究的目的是对长期重症监护的非中性粒细胞减少、念珠菌定植的外科患者进行全身抗真菌化疗疗效的回顾性批判性评估。
选取1991年和1992年海德堡大学医院麻醉重症监护病房（ICU）364例患者中的69例（54例男性和15例女性，年龄55.8岁[范围18 - 87岁]）进行研究。根据组织学阳性、血培养阳性或无菌腔隙分离的金标准，这69例患者中无一例患有确诊的侵袭性念珠菌病。然而，69例患者中有35例接受了氟康唑全身治疗（平均每天静脉注射295毫克，持续10.2天）。34例患者未接受任何抗真菌治疗。我们回顾性分析了两组患者的病程。此外，这些患者的173份血清样本可用于通过蛋白质印迹法检测免疫球蛋白M和G类抗念珠菌抗体。
抗真菌治疗组和未治疗组在基线时具有相似的特征：年龄、性别、基础疾病、疾病严重程度（急性生理与慢性健康状况评分II [APACHE II评分]）以及死亡率（两组均约为20%）。仅在ICU的时间和机械通气时间在氟康唑治疗组中显著延长（p值均为0.0004）。治疗前，氟康唑治疗组患者在主要非无菌腔隙中酵母菌的出现频率显著更高（卡方检验p = 0.05）。酵母菌部分被氟康唑清除（32/54，59.3%）。抗念珠菌抗体与较高年龄显著相关（抗47 kDa抗原，p = 0.02），但与其他临床、诊断或预后相关参数无关。
在长期ICU护理的非中性粒细胞减少、念珠菌定植的外科患者中，氟康唑既未改善临床病程，也未降低这些患者的死亡率。这些观察结果表明，在这类患者中存在高估念珠菌临床意义的趋势。此类患者的氟康唑治疗可能可显著减少。
