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[重症监护病房中的念珠菌血症]

[Candidemia in an intensive care unit].

作者信息

Adukauskiene Dalia, Kinderyte Aida, Dambrauskiene Asta, Vitkauskiene Astra

机构信息

Department of Intensive Care, Kaunas University of Medicine, Kaunas, Lithuania.

出版信息

Medicina (Kaunas). 2009;45(5):351-6.

Abstract

Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing. OBJECTIVE. To evaluate the pathogens of candidemia, risk factors and their influence on outcome. MATERIAL AND METHODS. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively. RESULTS. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05). CONCLUSIONS. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome.

摘要

由于即使是重症患者的生存率提高、抗菌药物的广泛使用以及侵入性操作和处置的数量增加,念珠菌血症正变得越来越常见。念珠菌血症的诊断仍然很复杂,治疗成本和死亡率也在上升。目的:评估念珠菌血症的病原体、危险因素及其对预后的影响。材料与方法:回顾性分析在考纳斯医科大学医院重症监护病房接受治疗的41例念珠菌属血培养阳性患者的数据。结果:48.8%(n = 20)的患者念珠菌血症由白色念珠菌引起,51.2%(n = 21)的患者由非白色念珠菌引起。2004年念珠菌血症的主要病因是白色念珠菌(83.3%,n = 5),但在2005年(63.6%,n = 7)、2006年(57.1%,n = 4)和2007年(52.9%,n = 9),主要病因是非白色念珠菌属。与2004年相比,2005年、2006年和2007年白色念珠菌引起的念珠菌血症病例数减少,非白色念珠菌属引起的念珠菌血症病例数也分别减少(P < 0.05)。超过65%(n = 34)的患者患有严重疾病(P < 0.05)。念珠菌血症患者的致死率为58.5%。非幸存者中76.9%(n = 20)使用机械通气,72.1%(n = 19)使用膀胱导管;幸存者中分别为23.1%(n = 6)和26.9%(n = 7)(P < 0.05)。结论:在4年期间,重症监护病房念珠菌血症的患病率有所增加;一半的念珠菌血症病例由非白色念珠菌属引起,非白色念珠菌属引起的念珠菌血症患者的死亡风险更高。因此,对于重症监护病房疑似侵袭性真菌感染的脓毒症情况进行经验性治疗时,在确定念珠菌血症的病原体之前,我们建议使用非唑类抗真菌药物。严重疾病被评估为念珠菌血症的危险因素。肿瘤疾病患者患非白色念珠菌属引起的念珠菌血症的风险显著更高。使用机械通气和膀胱导管是致死结局的危险因素。

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