Hsueh Po-Ren, Graybill John Richard, Playford E Geoffrey, Watcharananan Siriorn Paritpokee, Oh Myoung-Don, Ja'alam Kamarudin, Huang Shunwei, Nangia Vivek, Kurup Asok, Padiglione Alexander Angelo
Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Int J Antimicrob Agents. 2009 Sep;34(3):205-9. doi: 10.1016/j.ijantimicag.2009.03.014. Epub 2009 May 5.
Invasive candidiasis has emerged as an important nosocomial infection, especially in critically ill patients. The incidence of candidaemia in Intensive Care Units (ICUs) is 5- to 10-fold higher than in the entire hospital and the crude mortality rate of patients with candidaemia is between 35% and 60%. Candida albicans remains the predominant cause of invasive candidiasis in ICUs, followed by Candida tropicalis, Candida glabrata and Candida parapsilosis. Invasive isolates of Candida spp. remain highly susceptible to fluconazole (>90% susceptible), although among Asia-Pacific countries the susceptibility rate of C. glabrata to fluconazole varies widely from 22% to 72%. Early diagnosis and prompt initiation of antifungal therapy are crucial for the effective treatment of invasive candidiasis. However, invasive candidiasis is difficult to diagnose owing to its non-specific clinical features, and delayed therapy is a major contributor to poor outcomes. Combining clinical risk factors with Candida colonisation parameters appears promising for guiding early interventions. Because of considerable regional variability, local epidemiological knowledge is critical in the effective management of invasive candidiasis among ICU patients in Asia-Pacific.
侵袭性念珠菌病已成为一种重要的医院感染，尤其是在重症患者中。重症监护病房（ICU）中念珠菌血症的发病率比整个医院高出5至10倍，念珠菌血症患者的粗死亡率在35%至60%之间。白色念珠菌仍然是ICU中侵袭性念珠菌病的主要病因，其次是热带念珠菌、光滑念珠菌和近平滑念珠菌。念珠菌属的侵袭性分离株对氟康唑仍高度敏感（>90%敏感），尽管在亚太国家中，光滑念珠菌对氟康唑的敏感率差异很大，从22%到72%不等。早期诊断和及时开始抗真菌治疗对于侵袭性念珠菌病的有效治疗至关重要。然而，侵袭性念珠菌病因其非特异性临床特征而难以诊断，治疗延迟是导致不良预后的主要因素。将临床危险因素与念珠菌定植参数相结合似乎有望指导早期干预。由于存在相当大的地区差异，当地的流行病学知识对于亚太地区ICU患者侵袭性念珠菌病的有效管理至关重要。
