白色念珠菌与非白色念珠菌所致重症监护病房获得性血流感染：危险因素及转归的差异

Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome.

作者信息

Dimopoulos George, Ntziora Fotinie, Rachiotis George, Armaganidis Apostolos, Falagas Matthew E

机构信息

Intensive Care Unit, Sotiria Hospital, Athens, Greece.

出版信息

Anesth Analg. 2008 Feb;106(2):523-9, table of contents. doi: 10.1213/ane.0b013e3181607262.

DOI:10.1213/ane.0b013e3181607262

PMID:18227310

Abstract

OBJECTIVE

In this study we sought to identify differences in risk factors and outcome of critically ill patients with Candida albicans and non-albicans candidemia.

METHODS

Nonimmunosuppressed, nonneutropenic patients with candidemia diagnosed after intensive care unit (ICU) admission were included in a prospective observational study in a medical-surgical ICU at a tertiary academic hospital in Athens, Greece.

RESULTS

During the study period (January 2001 to December 2005), 56 candidemia episodes in 1037 ICU admissions were included (5.4%). Of these patients, 36/56 (64.3%) had candidemia due to C. albicans and 20/56 (35.7%) due to non-albicans species (8/56 [14.3%] C. glabrata, 6/56 [10.7%] C. tropicalis, 3/56 [5.4%] C. parapsilosis, 1/56 [1.8%] C. lusitaniae, 1/56 [1.8%] C. krusei and 1/56 [1.8%] C. dubliniensis). Administration of glucocorticosteroids, central venous catheter placement, and preexisting candiduria were independently associated with candidemia due to C. non-albicans species (Odds ratio [OR]: 45.1, 95% confidence interval [CI]: 3.0-669.9; OR: 26.2, 95% CI: 2.1-334.8; and OR: 16.5, 95% CI: 1.6-173.9, respectively). The treatment response rate differed significantly between patients with C. albicans and patients with C. non-albicans bloodstream infections (29/36 [80.6%] vs 9/20 [45%], P = 0.006). Overall mortality was higher in patients with non-albicans species than C. albicans bloodstream infections (18/20 [90%] vs 19/36 [52.8%], P = 0.005). Multivariable logistic regression analysis revealed that candidemia due to non-albicans species was independently associated with death (OR: 6.7, 95% CI: 1.2-37.7).

CONCLUSIONS

In the subset of critically ill nonimmunosuppressed patients, candidemia caused by non-albicans species occurred more frequently in those with medical devices or receiving steroids. Candidemia due to non-albicans species was also associated with higher mortality.

摘要

目的

在本研究中，我们试图确定白色念珠菌血症和非白色念珠菌血症的重症患者在危险因素和预后方面的差异。

方法

在希腊雅典一家三级学术医院的内科-外科重症监护病房（ICU）进行的一项前瞻性观察研究中，纳入了入住ICU后被诊断为念珠菌血症的非免疫抑制、非中性粒细胞减少的患者。

结果

在研究期间（2001年1月至2005年12月），1037例ICU入院患者中有56例发生念珠菌血症（5.4%）。在这些患者中，36/56（64.3%）为白色念珠菌引起的念珠菌血症，20/56（35.7%）为非白色念珠菌引起的念珠菌血症（8/56 [14.3%] 光滑念珠菌，6/56 [10.7%] 热带念珠菌，3/56 [5.4%] 近平滑念珠菌，1/56 [1.8%] 葡萄牙念珠菌，1/56 [1.8%] 克柔念珠菌，1/56 [1.8%] 都柏林念珠菌）。糖皮质激素的使用、中心静脉导管的放置以及先前存在的念珠菌尿与非白色念珠菌引起的念珠菌血症独立相关（比值比[OR]：45.1，95%置信区间[CI]：3.0 - 669.9；OR：26.2，95%CI：及OR：16.5，95%CI：1.6 - 173.9）。白色念珠菌血症患者和非白色念珠菌血流感染患者的治疗反应率有显著差异（29/36 [80.6%] 对9/20 [45%]，P = 0.006）。非白色念珠菌血流感染患者的总体死亡率高于白色念珠菌血流感染患者（18/20 [90%] 对19/36 [52.8%]，P = 0.005）。多变量逻辑回归分析显示，非白色念珠菌引起的念珠菌血症与死亡独立相关（OR：6.7，95%CI：1.2 - 37.7）。