University of Houston College of Pharmacy, 1441 Moursund Street, Houston, TX 77030, USA.
J Antimicrob Chemother. 2011 Sep;66(9):2146-51. doi: 10.1093/jac/dkr244. Epub 2011 Jun 23.
Definitive antifungal therapy is typically based on Candida species and clinical status, rather than susceptibility reports. Antifungal susceptibility testing is available, but the impact on treatment decisions is unknown. The purpose of this study was to assess antifungal therapy in hospitalized patients with candidaemia during the time period between the start of empirical therapy and after antifungal susceptibility testing reports are available.
A retrospective study of 161 hospitalized patients with candidaemia was conducted. Patients who received fluconazole or an echinocandin were evaluated for changes in empirical antifungal therapy prior to and after susceptibility reporting.
One hundred and sixty-one patients aged 59 ± 16 years (male, 54%; Caucasian, 52%; APACHE II score ≥ 15, 48%; and intensive care unit, 50%) were identified, of whom 130 (81%) had fluconazole-susceptible candidaemia. Fifty-eight patients (36%) were initiated on fluconazole and 103 (64%) on an echinocandin. The mean time from culture to the susceptibility report was 5 ± 2 days. Prior to availability of the susceptibility report, 20 fluconazole-initiated patients (34%) were switched to an echinocandin, while 14 echinocandin-initiated patients (14%) were switched to fluconazole. Once a susceptibility report was available, 35 of 89 (39%) patients with fluconazole-susceptible candidaemia on an echinocandin were de-escalated to fluconazole. Eleven patients on fluconazole just prior to a susceptibility report were identified with a fluconazole-resistant Candida species.
Using antifungal susceptibility testing, patients given fluconazole with fluconazole-resistant Candida species were identified. Less than 40% of echinocandin-treated patients with fluconazole-susceptible organisms were de-escalated to fluconazole. Antifungal susceptibility testing may help to identify patients in need of clinical intervention.
明确的抗真菌治疗通常基于念珠菌物种和临床状况，而不是药敏报告。抗真菌药敏试验是可用的，但对治疗决策的影响尚不清楚。本研究的目的是评估经验性治疗开始后至抗真菌药敏报告可用期间住院念珠菌血症患者的抗真菌治疗情况。
对 161 例住院念珠菌血症患者进行回顾性研究。评估了在药敏报告之前和之后接受氟康唑或棘白菌素治疗的患者经验性抗真菌治疗的变化。
共确定了 161 例年龄 59±16 岁（男性 54%；白种人 52%；APACHE II 评分≥15 者 48%；入住重症监护病房者 50%）的患者，其中 130 例（81%）患有氟康唑敏感念珠菌血症。58 例（36%）患者开始使用氟康唑，103 例（64%）患者开始使用棘白菌素。从培养到药敏报告的平均时间为 5±2 天。在获得药敏报告之前，20 例氟康唑起始治疗的患者（34%）被转换为棘白菌素，而 14 例棘白菌素起始治疗的患者（14%）被转换为氟康唑。一旦获得药敏报告，89 例氟康唑敏感念珠菌血症患者中有 35 例（39%）接受棘白菌素治疗的患者降级为氟康唑。在药敏报告之前，有 11 例氟康唑治疗的患者被鉴定为氟康唑耐药的念珠菌属。
使用抗真菌药敏试验，鉴定出了使用氟康唑治疗且为氟康唑耐药的念珠菌属的患者。不到 40%的接受棘白菌素治疗且为氟康唑敏感的患者降级为氟康唑。抗真菌药敏试验可能有助于识别需要临床干预的患者。
