Horn David L, Neofytos Dionissios, Anaissie Elias J, Fishman Jay A, Steinbach William J, Olyaei Ali J, Marr Kieren A, Pfaller Michael A, Chang Chi-Hsing, Webster Karen M
Div. of Infectious Diseases, Thomas Jefferson University, Ste. 210, 211 S. 9th St., Philadelphia, PA 19107, USA.
Clin Infect Dis. 2009 Jun 15;48(12):1695-703. doi: 10.1086/599039.
Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing.
Clinical data from patients with candidemia were extracted from the Prospective Antifungal Therapy (PATH) Alliance database, a comprehensive registry that collects information regarding invasive fungal infections. A total of 2019 patients, enrolled from 1 July 2004 through 5 March 2008, were identified. Data regarding the candidemia episode were analyzed, including the specific fungal species and patient survival at 12 weeks after diagnosis.
The incidence of candidemia caused by non-Candida albicans Candida species (54.4%) was higher than the incidence of candidemia caused by C. albicans (45.6%). The overall, crude 12-week mortality rate was 35.2%. Patients with Candida parapsilosis candidemia had the lowest mortality rate (23.7%; P<.001) and were less likely to be neutropenic (5.1%; P<.001) and to receive corticosteroids (33.5%; P<.001) or other immunosuppressive drugs (7.9%; P=.002), compared with patients infected with other Candida species. Candida krusei candidemia was most commonly associated with prior use of antifungal agents (70.6%; P<.001), hematologic malignancy (52.9%; P<.001) or stem cell transplantation (17.7%; P<.001), neutropenia (45.1%; P<.001), and corticosteroid treatment (60.8%; P<.001). Patients with C. krusei candidemia had the highest crude 12-week mortality in this series (52.9%; P<.001). Fluconazole was the most commonly administered antimicrobial, followed by the echinocandins, and amphotericin B products were infrequently administered.
The epidemiology and choice of therapy for candidemia are rapidly changing. Additional study is warranted to differentiate host factors and differences in virulence among Candida species and to determine the best therapeutic regimen.
念珠菌血症仍然是医疗环境中发病和死亡的主要原因，并且念珠菌感染的流行病学正在发生变化。
从前瞻性抗真菌治疗（PATH）联盟数据库中提取念珠菌血症患者的临床数据，该数据库是一个收集有关侵袭性真菌感染信息的综合登记处。共确定了2019例患者，这些患者于2004年7月1日至2008年3月5日入组。分析了念珠菌血症发作的数据，包括特定真菌种类以及诊断后12周时患者的生存率。
非白色念珠菌引起的念珠菌血症发生率（54.4%）高于白色念珠菌引起的念珠菌血症发生率（45.6%）。总体粗略的12周死亡率为35.2%。近平滑念珠菌血症患者的死亡率最低（23.7%；P<0.001），与感染其他念珠菌种类的患者相比，中性粒细胞减少的可能性较小（5.1%；P<0.001），接受皮质类固醇治疗的可能性较小（33.5%；P<0.001）或接受其他免疫抑制药物治疗的可能性较小（7.9%；P=0.002）。克柔念珠菌血症最常与先前使用抗真菌药物（70.6%；P<0.001）、血液系统恶性肿瘤（52.9%；P<0.001）或干细胞移植（17.7%；P<0.001）、中性粒细胞减少（45.1%；P<0.001）以及皮质类固醇治疗（60.8%；P<0.001）相关。在本系列中，克柔念珠菌血症患者的粗略12周死亡率最高（52.9%；P<0.001）。氟康唑是最常用的抗菌药物，其次是棘白菌素类，两性霉素B产品使用较少。
念珠菌血症的流行病学和治疗选择正在迅速变化。有必要进行更多研究以区分宿主因素以及念珠菌种类之间毒力的差异，并确定最佳治疗方案。
