Barenfanger Joan, Arakere Pushpalatha, Cruz Rafael Dela, Imran Adil, Drake Cheryl, Lawhorn Jerry, Verhulst Steven J, Khardori Nancy
Laboratory Medicine, Memorial Medical Center, Springfield, Illinois 62781, USA.
J Clin Microbiol. 2003 Dec;41(12):5645-9. doi: 10.1128/JCM.41.12.5645-5649.2003.
Pneumonia due to infection with Candida spp. is extremely rare even though these yeasts are commonly cultured from respiratory secretions. The diagnosis of pneumonia due to Candida spp. should be made only by demonstrating tissue invasion of a biopsy specimen. Physicians might misinterpret the presence of Candida spp. in respiratory secretions as being the etiological agent of pneumonia. This study describes the practice of limiting identification (ID) of rapidly growing yeasts (i.e., Candida spp.) in respiratory secretions and its impact on patients. Before November 2001, rapidly growing yeasts found in respiratory secretions were identified to the species level. After November, rapidly growing yeasts were reported as "yeasts, not Cryptococcus." The group of patients with respiratory secretions processed before November 2001 is called the full ID group (n = 267); the group with samples processed after that date is called the limited ID group (n = 77). Full ID patients had an average length of hospital stay of 12.1 days/patient; that of limited ID patients was 10.1 days/patient, a decrease of 2 days/patient (P = 0.02). The full ID patients had an average cost of 9,407 dollars/patient; that of limited ID patients was 6,973 dollars/patient, a decrease of 2,434 dollars/patient (P = 0.03). Antifungal medications were used in 103 of 267 (39%) full ID patients and in 16 of 77 (21%) limited ID patients, a decrease of 18% (P = 0.004). Limited ID patients had a mortality rate of 14.3%; that of full ID patients was 18.7%, a decrease of 4.4% (P = 0.37). This policy of limiting yeast ID did not impair the diagnosis of pneumonia. Rather, decreases in lengths of stay, costs, and administration of unnecessary antifungal therapy were observed after instituting this policy.
尽管念珠菌属酵母菌通常可从呼吸道分泌物中培养出来，但由念珠菌属感染引起的肺炎极为罕见。念珠菌属肺炎的诊断仅应通过活检标本显示组织侵袭来做出。医生可能会将呼吸道分泌物中念珠菌属的存在误解为肺炎的病原体。本研究描述了限制呼吸道分泌物中快速生长酵母菌（即念珠菌属）鉴定（ID）的做法及其对患者的影响。2001年11月之前，在呼吸道分泌物中发现的快速生长酵母菌被鉴定到种水平。11月之后，快速生长酵母菌报告为“酵母菌，非隐球菌”。2001年11月之前处理呼吸道分泌物的患者组称为完全鉴定组（n = 267）；该日期之后处理样本的组称为有限鉴定组（n = 77）。完全鉴定组患者的平均住院时间为12.1天/患者；有限鉴定组患者为10.1天/患者，每位患者减少2天（P = 0.02）。完全鉴定组患者的平均费用为9407美元/患者；有限鉴定组患者为6973美元/患者，每位患者减少2434美元（P = 0.03）。267例（39%）完全鉴定组患者中有103例使用了抗真菌药物，77例（21%）有限鉴定组患者中有16例使用，减少了18%（P = 0.004）。有限鉴定组患者的死亡率为14.3%；完全鉴定组患者为18.7%，降低了4.4%（P = 0.37）。这种限制酵母菌鉴定的策略并未损害肺炎的诊断。相反，实施该策略后观察到住院时间、费用以及不必要抗真菌治疗的使用均有所减少。
