Peter MacCallum Cancer Centre and the Centre for Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Parkville, VIC 3050, Australia.
J Antimicrob Chemother. 2010 May;65(5):1042-51. doi: 10.1093/jac/dkq053. Epub 2010 Mar 4.
Candidaemia in cancer patients is associated with increasing fluconazole resistance. Models for predicting such isolates and their clinical impact are required.
Clinical, treatment and outcome data from a population-based candidaemia survey (2001-2004) were collected at 5 and 30 days after diagnosis. Speciation and antifungal susceptibility testing was performed.
There were 138 candidaemia episodes (33% Candida albicans) in adults with haematological malignancies and 150 (51% C. albicans) in adults with solid organ malignancies. Thirty-nine isolates had fluconazole MICs of >or=64 mg/L and 40 had MICs of 16-32 mg/L (predominantly Candida glabrata and Candida krusei). By multivariate analysis, triazole therapy, gastrointestinal tract (GIT) surgery in the 30 days before candidaemia and age >65 years were predictive of fluconazole-resistant candidaemia. Thirty day crude mortality was 40% in haematology patients and 45% in oncology patients. Fluconazole-resistant isolates were associated with increased risk of mortality by univariate (P = 0.04) and Kaplan-Meier survival analyses. By Cox proportional hazards modelling, the strongest predictors of mortality at onset of candidaemia were invasive ventilation, elevated creatinine, intensive care unit (ICU) admission and receipt of systemic triazoles or corticosteroids in the previous 30 days. Removal of a central venous access device (CVAD) at or within 5 days of onset was associated with decreased mortality.
Risk factors for fluconazole-resistant candidaemia in adults with cancer include fluconazole/triazole exposure and GIT surgery. ICU admission, invasive ventilation, renal impairment, age >65 years and prior exposure to corticosteroids and triazoles are risk factors for death. CVAD removal reduced mortality. These findings should be integrated into surveillance and treatment algorithms.
癌症患者的念珠菌血症与氟康唑耐药率的增加有关。需要建立预测此类分离株及其临床影响的模型。
对 5 天和 30 天的临床、治疗和预后数据进行了基于人群的念珠菌血症调查（2001-2004 年）。进行了种属鉴定和抗真菌药敏试验。
在血液系统恶性肿瘤患者中，有 138 例念珠菌血症（33%为白色念珠菌），实体器官恶性肿瘤患者中，有 150 例（51%为白色念珠菌）。39 株氟康唑 MIC 值大于或等于 64mg/L，40 株氟康唑 MIC 值为 16-32mg/L（主要为光滑念珠菌和克柔念珠菌）。多变量分析显示，唑类药物治疗、念珠菌血症前 30 天胃肠道（GIT）手术以及年龄大于 65 岁与氟康唑耐药念珠菌血症相关。血液系统恶性肿瘤患者的 30 天死亡率为 40%，肿瘤患者的死亡率为 45%。氟康唑耐药株与死亡率增加有关（P = 0.04）。单因素和 Kaplan-Meier 生存分析表明，氟康唑耐药株与死亡率增加有关。通过 Cox 比例风险模型，念珠菌血症发病时的最强死亡预测因素是侵入性通气、肌酐升高、入住重症监护病房（ICU）以及在发病前 30 天内接受全身性唑类药物或皮质激素治疗。发病后或发病后 5 天内取出中心静脉置管（CVAD）与死亡率降低相关。
癌症成人中氟康唑耐药性念珠菌血症的危险因素包括氟康唑/唑类药物暴露和 GIT 手术。入住 ICU、侵入性通气、肾功能损害、年龄大于 65 岁以及先前暴露于皮质激素和唑类药物是死亡的危险因素。取出 CVAD 可降低死亡率。这些发现应纳入监测和治疗方案中。
