Hôpital Avicenne, Service de Réanimation, Bobigny, France.
Crit Care Med. 2010 Mar;38(3):826-30. doi: 10.1097/CCM.0b013e3181cc4734.
Candida species represent the fourth cause of nosocomial bloodstream infections worldwide. Because Candida glabrata has become the second most frequently identified yeast and because the rate of fluconazole-resistant C. glabrata strains reaches 10% to 15%, initial antifungal therapy based on fluconazole in nonneutropenic hemodynamically stable patients, as recommended by current guidelines, may be an ineffective option. Our aim was to determine easy-to-identify risk factors for C. glabrata fungemia likely to guide and improve initial antifungal therapy.
Prospective multicenter cohort study.
Five French intensive care units.
Consecutive nonneutropenic patients without known Candida colonization who had blood culture-confirmed fungemia over a 4-yr period.
None.
A total of 8206 patients were screened. One hundred fifty-four patients with blood culture-confirmed fungemia constituted the cohort, of whom 48 had C. glabrata fungemia and 106 had nonglabrata fungemia. Patients' baseline characteristics and in-intensive care unit events potentially related to C. glabrata fungemia were systematically recorded. Compared with patients with nonglabrata fungemia, patients with C. glabrata fungemia were older and more severely ill, had received more antibiotics, and were more likely to have undergone surgery. The stepwise logistic regression analysis identified six independent risk factors for C. glabrata fungemia: age >60 yrs, recent abdominal surgery, interval from intensive care unit admission to first positive blood culture <or=7 days, recent use of cephalosporins, solid tumor, and absence of diabetes mellitus. The model showed satisfying goodness of fit (Hosmer-Lemeshow statistic = .26) and discrimination (c statistic = .89).
We found six early available and easy-to-identify risk factors for C. glabrata fungemia. When these factors are present, alternatives to fluconazole for initial antifungal therapy should be considered.
假丝酵母菌属是全球第四大医院获得性血流感染病原菌。由于光滑假丝酵母菌已成为第二大常见酵母菌，且氟康唑耐药光滑假丝酵母菌的发生率达到 10%~15%，因此目前指南推荐对非中性粒细胞减少、血流动力学稳定的患者，初始抗真菌治疗采用氟康唑可能效果不佳。本研究旨在确定易识别的光滑假丝酵母菌菌血症危险因素，以便指导和改善初始抗真菌治疗。
前瞻性多中心队列研究。
法国 5 家重症监护病房。
连续筛选出 4 年中未经已知假丝酵母菌定植但血培养确诊为真菌血症的非中性粒细胞减少患者。
无。
共筛选出 8206 例患者，其中 154 例血培养确诊为真菌血症患者纳入本研究队列，48 例为光滑假丝酵母菌菌血症，106 例为非光滑假丝酵母菌菌血症。系统记录了患者的基线特征和入住重症监护病房期间可能与光滑假丝酵母菌菌血症相关的事件。与非光滑假丝酵母菌菌血症患者相比，光滑假丝酵母菌菌血症患者年龄更大、病情更重，接受了更多的抗生素治疗，且更可能接受过手术。逐步逻辑回归分析确定了 6 个与光滑假丝酵母菌菌血症相关的独立危险因素：年龄＞60 岁、近期腹部手术、入住重症监护病房至首次阳性血培养时间≤7 天、近期使用头孢菌素、实体瘤和无糖尿病。该模型具有良好的拟合优度（Hosmer-Lemeshow 统计量=0.26）和区分度（C 统计量=0.89）。
我们发现了 6 个光滑假丝酵母菌菌血症早期易识别的危险因素。当存在这些危险因素时，应考虑氟康唑以外的其他药物作为初始抗真菌治疗的选择。
