Cheng Yu-Ren, Lin Li-Chen, Young Tzuu-Guang, Liu Chun-Eng, Chen Chang-Hua, Tsay Ren-Wen
Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
J Microbiol Immunol Infect. 2006 Apr;39(2):155-61.
Bloodstream infections due to Candida spp. are associated with significant mortality and morbidity. This study analysed the epidemiology and outcome of candidemia cases in a teaching hospital in central Taiwan.
We retrospectively studied the clinical characteristics and antifungal susceptibility of isolates and risk factors for mortality in 91 cases of candidemia treated from January 1, 2001 to June 30, 2003.
The mean age of the patients was 67 years (range, 30-90 years). Three episodes (3%) were community acquired. Adequate antifungal therapy was given to 78 patients (78%). Cancer (38.5%) and diabetes mellitus (36.3%) were the 2 most common underlying diseases. The most frequent risk factors identified for candidemia were prior broad-spectrum antibiotic use (84.6%), central venous catheterization (83.5%) and Candida colonization (79.5%). The most frequent isolates were Candida albicans (64.8%) and Candida tropicalis (19.8%). All of the C. albicans and C. tropicalis isolates were sensitive to fluconazole (minimal inhibitory concentration <or=8 microg/mL). Susceptibility to amphotericin B and fluconazole was found in 96.7% (88/91) and 95.6% (87/91) of Candida spp., respectively. Risk factors for mortality due to candidemia in the univariate analysis included central venous catheterization, shock, and high Acute Physiology and Chronic Health Evaluation II (APACHE II) score. APACHE II score was the only independent prognostic factor in the multivariate analysis.
Candidemia has a high mortality rate and C. albicans remains the most common isolate. Fluconazole and amphotericin B maintained good in vitro antifungal activity against Candida spp. APACHE II score was the only independent factor for mortality in patients with candidemia.
念珠菌属引起的血流感染与显著的死亡率和发病率相关。本研究分析了台湾中部一家教学医院念珠菌血症病例的流行病学及转归情况。
我们回顾性研究了2001年1月1日至2003年6月30日期间接受治疗的91例念珠菌血症患者的临床特征、分离菌株的抗真菌药敏情况及死亡危险因素。
患者的平均年龄为67岁（范围30 - 90岁）。3例（3%）为社区获得性感染。78例患者（78%）接受了充分的抗真菌治疗。癌症（38.5%）和糖尿病（36.3%）是最常见的两种基础疾病。念珠菌血症最常见的危险因素是既往使用广谱抗生素（84.6%）、中心静脉置管（83.5%）和念珠菌定植（79.5%）。最常见的分离菌株是白色念珠菌（64.8%）和热带念珠菌（19.8%）。所有白色念珠菌和热带念珠菌分离株对氟康唑敏感（最低抑菌浓度≤8μg/mL）。念珠菌属对两性霉素B和氟康唑的敏感率分别为96.7%（88/91）和95.6%（87/91）。单因素分析中念珠菌血症死亡的危险因素包括中心静脉置管、休克和高急性生理与慢性健康状况评分系统II（APACHE II）评分。多因素分析中APACHE II评分是唯一的独立预后因素。
念珠菌血症死亡率高，白色念珠菌仍是最常见的分离菌株。氟康唑和两性霉素B对念珠菌属保持良好的体外抗真菌活性。APACHE II评分是念珠菌血症患者死亡的唯一独立因素。
