Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
J Infect. 2013 Mar;66(3):278-84. doi: 10.1016/j.jinf.2012.11.002. Epub 2012 Nov 19.
To investigate the risk factors and outcomes associated with Candida krusei bloodstream.
We performed a case control study of patients with C. krusei bloodstream infection at the University of Pennsylvania from 1982 to 2010. Controls were without candidemia, and matched to cases on duration of hospitalization and underlying disease.
We enrolled 34 cases and 114 matched controls. Most subjects (62%) had hematologic malignancies. In the multivariate model, including a priori the duration of fluconazole use (OR 1.06; 95% CI 1.00, 1.11) and days of neutropenia (OR 1.01; 95% CI 0.98, 1.13), risk factors associated with C. krusei bloodstream infection were splenectomy (OR 11.66; 95% CI 1.04, 130.64), and exposure to antimicrobials with anaerobic activity (OR 5.74; 95% CI 1.76, 18.67). Outcomes of infected patients were poor. Only 32% of case patients survived to hospital discharge, compared to 89% of controls. For 48% death was attributed to C. krusei infection.
C. krusei bloodstream infection occurs most commonly in neutropenic patients with hematologic malignancy. The association with prior fluconazole exposure is less marked than previously described. Splenectomy and the receipt of antimicrobials with anaerobic activity are significant risk factors. The outcome of infected patients remains poor, despite appropriate antifungal therapy.
研究与克柔念珠菌血流感染相关的危险因素和结局。
我们对 1982 年至 2010 年期间在宾夕法尼亚大学发生克柔念珠菌血流感染的患者进行了病例对照研究。对照组无念珠菌血症，与病例组在住院时间和基础疾病方面相匹配。
我们纳入了 34 例病例和 114 例匹配的对照组。大多数患者（62%）患有血液系统恶性肿瘤。在包括氟康唑使用时间（比值比 1.06；95%置信区间 1.00，1.11）和中性粒细胞减少天数（比值比 1.01；95%置信区间 0.98，1.13）在内的多变量模型中，与克柔念珠菌血流感染相关的危险因素是脾切除术（比值比 11.66；95%置信区间 1.04，130.64）和使用具有抗厌氧菌活性的抗菌药物（比值比 5.74；95%置信区间 1.76，18.67）。感染患者的结局较差。仅有 32%的病例患者存活至出院，而对照组为 89%。48%的死亡归因于克柔念珠菌感染。
克柔念珠菌血流感染最常发生于中性粒细胞减少的血液系统恶性肿瘤患者中。与氟康唑暴露的相关性不如以前描述的那么显著。脾切除术和使用具有抗厌氧菌活性的抗菌药物是显著的危险因素。尽管进行了适当的抗真菌治疗，感染患者的结局仍然较差。
