Department of Microbiological Surveillance and Research, Division of Microbiology and Diagnostics, Statens Serum Institute, Copenhagen, Denmark.
Curr Opin Crit Care. 2010 Oct;16(5):445-52. doi: 10.1097/MCC.0b013e32833e84d2.
This review covers candidaemia in numbers, susceptibility issues, host groups, risk factors and outcome.
The incidence of candidaemia has increased over the last decades. Candida glabrata is particularly common in the northern hemisphere and with increasing age whilst the opposite is true for C. parapsilosis, C. glabrata, C. krusei and a number of emerging species are not fully susceptible to azoles. C. parapsilosis and C. guilliermondii are not fully susceptible to echinocandins. Increasing rates of C. parapsilosis have been observed at centres with a high use of echinocandins, and outcome for this species is not superior comparing echinocandins with fluconazole. Acquired azole resistance has recently been described in as many as a third of 19% resistant isolates and echinocandin resistance has emerged and been detected as early as day 12 of echinocandin therapy. ICU stay and abdominal surgery are among the most important risk factors. Outcome is dependent on species involved, timing, dosing and choice of therapy and management of the primary focus of infection. However, host factors are dominating predictors of mortality in recent studies of ICU candidiasis.
The changing epidemiology highlights the need for close monitoring of local incidence, species distribution and susceptibility in order to optimize therapy and outcome.
本文涵盖了念珠菌血症的发病情况、药敏问题、宿主群体、危险因素和预后。
在过去几十年中，念珠菌血症的发病率一直在增加。在北半球，随着年龄的增长，近平滑念珠菌越来越常见，而副念珠菌则相反；克柔念珠菌、光滑念珠菌和许多新兴物种对唑类药物不完全敏感；近平滑念珠菌和假热带念珠菌对棘白菌素类药物不完全敏感。在棘白菌素类药物使用率较高的中心，观察到近平滑念珠菌的发生率不断增加，与氟康唑相比，该菌使用棘白菌素类药物的预后并不占优势。最近有报道称多达三分之一的 19%耐药分离株出现了获得性唑类耐药，而且棘白菌素类耐药已经出现，并在使用棘白菌素类药物治疗的第 12 天就被检测到。重症监护病房停留时间和腹部手术是最重要的危险因素之一。预后取决于所涉及的物种、时机、剂量和治疗选择以及感染的主要焦点的管理。然而，在最近的 ICU 念珠菌病研究中，宿主因素是死亡率的主要预测因素。
不断变化的流行病学突显了密切监测当地发病率、物种分布和药敏情况的必要性，以便优化治疗和预后。
