癌症免疫功能低下患者中光滑念珠菌和白色念珠菌血症的流行病学

The epidemiology of Candida glabrata and Candida albicans fungemia in immunocompromised patients with cancer.

作者信息

Bodey Gerald P, Mardani Masoud, Hanna Hend A, Boktour Maha, Abbas Jalal, Girgawy Essam, Hachem Ray Y, Kontoyiannis Dimitrios P, Raad Issam I

机构信息

Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.

出版信息

Am J Med. 2002 Apr 1;112(5):380-5. doi: 10.1016/s0002-9343(01)01130-5.

DOI:10.1016/s0002-9343(01)01130-5

PMID:11904112

Abstract

PURPOSE

Candida glabrata is an increasing cause of candidemia, especially at cancer and bone marrow transplant centers where fluconazole is used for antifungal prophylaxis. This yeast is less susceptible to fluconazole in vitro than is Candida albicans. We compared the characteristics of patients who had C. glabrata and C. albicans candidemia at a large cancer center.

SUBJECTS AND METHODS

We searched the microbiological laboratory reports and identified 116 cases of C. glabrata candidemia between 1993 and 1999. The 116 cases of C. albicans candidemia that occurred most closely in time (before or after each case of C. glabrata candidemia) served as the control group. Data were collected from patients' medical records.

RESULTS

When compared with patients who had C. albicans infection, patients with C. glabrata candidemia more often had an underlying hematologic malignancy (68 [59%] vs. 26 [22%], P = 0.0001), had an Acute Physiology and Chronic Health Evaluation (APACHE) II score > or =16 (55 [48%] vs. 28 [25%], P = 0.0002), and received fluconazole prophylaxis (57 [49%] vs. 8 [7%], P = 0.0001). Patients with C. albicans candidemia more often had concomitant infections (101 [87%] vs. 78 [67%], P = 0.0003) and septic thrombophlebitis (11 [10%] vs. 2 [2%], P = 0.01). Among patients treated with antifungal therapy, those with C. albicans candidemia had a significantly greater overall response to therapy (83/104 [80%] vs. 60/97 [62%], P = 0.005) and to primary therapy (74/104 [71%] vs. 45/97 [46%], P = 0.0003). Amphotericin B preparations were not more effective than fluconazole (19/45 [42%] vs. 20/38 [53%], P = 0.5) in patients with C. glabrata candidemia. Fluconazole was less effective against C. glabrata than against C. albicans (20/38 [53%] vs. 57/74 [77%], P = 0.008).

CONCLUSION

C. glabrata has emerged as an important cause of candidemia, especially among neutropenic patients who receive fluconazole prophylaxis.

摘要

目的

光滑念珠菌引起念珠菌血症的情况日益增多，尤其在使用氟康唑进行抗真菌预防的癌症和骨髓移植中心。这种酵母菌在体外对氟康唑的敏感性低于白色念珠菌。我们比较了一家大型癌症中心发生光滑念珠菌血症和白色念珠菌血症患者的特征。

对象与方法

我们检索了微生物实验室报告，确定了1993年至1999年间116例光滑念珠菌血症病例。将在时间上最接近（在每例光滑念珠菌血症病例之前或之后）发生的116例白色念珠菌血症病例作为对照组。从患者病历中收集数据。

结果

与白色念珠菌感染患者相比，光滑念珠菌血症患者更常患有潜在的血液系统恶性肿瘤（68例[59%]对26例[22%]，P = 0.0001），急性生理与慢性健康状况评估（APACHE）II评分≥16分（55例[48%]对28例[25%]，P = 0.0002），并且接受氟康唑预防（57例[49%]对8例[7%]，P = 0.0001）。白色念珠菌血症患者更常伴有合并感染（101例[87%]对78例[67%]，P = 0.0003）和脓毒性血栓性静脉炎（11例[10%]对2例[2%]，P = 0.01）。在接受抗真菌治疗的患者中，白色念珠菌血症患者对治疗的总体反应（83/104[80%]对60/97[62%]，P = 0.005）和对初始治疗的反应（74/104[71%]对45/97[46%]，P = 0.0003）明显更好。在光滑念珠菌血症患者中，两性霉素B制剂并不比氟康唑更有效（19/45[42%]对20/38[53%]，P = 0.5）。氟康唑对光滑念珠菌的疗效低于对白色念珠菌的疗效（20/38[53%]对57/74[77%]，P = 0.008）。