Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
J Antimicrob Chemother. 2010 Mar;65(3):562-8. doi: 10.1093/jac/dkp495. Epub 2010 Jan 18.
To assess the influence of new antifungal treatments on candidaemia outcome.
Candidaemia episodes prospectively collected through a blood culture surveillance programme in a single institution. The study was divided into two periods of time, 1994-2003 (A) and 2004-2008 (B), according to the introduction of echinocandin treatment. Non-conditional logistic regression methods with mortality as the dependent variable were used.
Four hundred and thirty-three (3%) candidaemias out of 15 628 bloodstream infection episodes were analysed. Candida albicans was the most frequent species (211; 49%). Mortality was noted in 132 cases (30%). A total of 262 and 171 candidaemias were reported in period A and B, respectively. There were 94 deaths in period A (36%) and 38 in period B (22%, P = 0.03). Treatment in period A was amphotericin B in 89 patients (41 dead, 46%) and fluconazole in 151 (41 dead, 27%, P = 0.003). In period B, 113 patients received a triazole (26 dead, 23%), 30 an echinocandin (3 dead, 10%, P = 0.08) and 9 (0 dead) were treated with combined therapy (echinocandin and triazole). Mortality was higher in period A (94 dead, 36%) than in period B (38 dead, 27%), P = 0.03. Independent risk factors associated with mortality in period B were: age, chronic renal failure, ultimately or rapidly fatal prognosis of underlying disease and shock. Echinocandin alone or in combination therapy was associated with better outcome (odds ratio = 0.22, 95% confidence interval = 0.06-0.81, P = 0.02).
In patients with candidaemia, echinocandin therapy results in a better outcome.
评估新型抗真菌治疗对念珠菌血症结局的影响。
通过单家机构的血液培养监测计划前瞻性收集念珠菌血症病例。研究根据棘白菌素治疗的引入分为两个时间段，1994-2003 年（A 期）和 2004-2008 年（B 期）。使用以死亡率为因变量的非条件逻辑回归方法。
在 15628 例血流感染病例中，分析了 433 例（3%）念珠菌血症。最常见的菌种是白色念珠菌（211 例；49%）。132 例（30%）有死亡记录。A 期报告了 262 例，B 期报告了 171 例。A 期有 94 例死亡（36%），B 期有 38 例死亡（22%，P=0.03）。A 期治疗方案中，89 例患者使用两性霉素 B（41 例死亡，46%），151 例患者使用氟康唑（41 例死亡，27%，P=0.003）。B 期有 113 例患者接受三唑类药物治疗（26 例死亡，23%），30 例患者接受棘白菌素治疗（3 例死亡，10%，P=0.08），9 例（0 例死亡）接受联合治疗（棘白菌素和三唑类药物）。A 期死亡率（94 例死亡，36%）高于 B 期（38 例死亡，27%，P=0.03）。B 期与死亡率相关的独立危险因素包括：年龄、慢性肾衰竭、基础疾病的最终或快速致命预后和休克。单独使用棘白菌素或联合治疗与更好的结局相关（比值比=0.22，95%置信区间=0.06-0.81，P=0.02）。
在念珠菌血症患者中，棘白菌素治疗可获得更好的结局。
