Tang Hung-Jen, Liu Wei-Lun, Lin Hsin-Lan, Lai Chih-Cheng
Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
PLoS One. 2014 Jun 5;9(6):e99103. doi: 10.1371/journal.pone.0099103. eCollection 2014.
The study of candidemia in cancer patients has been limited. This retrospective study aims to investigate the epidemiologic characteristics and prognostic factors of candidemia among cancer patients.
From 2009 to 2012, cancer patients with candidemia were identified at a hospital in Taiwan. The medical records of all patients with bloodstream infections due to Candida species were retrospectively reviewed.
During the four-year period, a total of 242 episodes of candidemia were identified among cancer patients. Half of these patients were classified as elderly (≥65 years old), and more than 95% of the candidemia episodes were classified as healthcare-associated infections. Among the 242 cancer patients with candidemia, head and neck cancer was the most common, followed by gastrointestinal tract and lung cancer. Additionally, most of the patients had variable underlying conditions, such as the presence of CVC (99%) or prior exposure to broad-spectrum antibiotics (93%) and were receiving an immunosuppressant (86%). Overall, C. albicans (n = 132, 54.5%) was the most common pathogen, followed by C. tropicalis (n = 52, 21.5%), C. parapsilosis (n = 38, 15.7%), and C. glabrata (n = 29, 12.0%). Seventeen patients had polycandidal candidemia, and 77 patients had concomitant bacteremia. Approximately one-third of the patients required admission to the intensive care unit (ICU) or mechanical ventilation, and the overall in-hospital mortality was 50.8%. Multivariable analysis showed that the in-hospital mortality was significantly associated with only the non-use of antifungal agents and acute respiratory failure (P<.001).
Candidemia can develop in patients with both solid cancer and hematological malignancy, especially for patients with underlying conditions. Overall, the associated morbidity and mortality due to Candidemia remain high. It was also determined that the non-use of antifungal agents and acute respiratory failure conditions were associated with in-hospital mortality.
对癌症患者念珠菌血症的研究一直有限。这项回顾性研究旨在调查癌症患者念珠菌血症的流行病学特征和预后因素。
2009年至2012年期间，在台湾一家医院确定了患有念珠菌血症的癌症患者。对所有念珠菌属引起的血流感染患者的病历进行回顾性审查。
在这四年期间，癌症患者中共发现242例念珠菌血症发作。其中一半患者被归类为老年人（≥65岁），超过95% 的念珠菌血症发作被归类为医疗保健相关感染。在242例患有念珠菌血症的癌症患者中，头颈癌最为常见，其次是胃肠道癌和肺癌。此外，大多数患者有多种基础疾病，如存在中心静脉导管（99%）或先前使用过广谱抗生素（93%）以及正在接受免疫抑制剂治疗（86%）。总体而言，白色念珠菌（n = 132，54.5%）是最常见的病原体，其次是热带念珠菌（n = 52，21.5%）、近平滑念珠菌（n = 38，15.7%）和光滑念珠菌（n = 29，12.0%）。17例患者有多发性念珠菌血症，77例患者伴有菌血症。约三分之一的患者需要入住重症监护病房（ICU）或进行机械通气，总体住院死亡率为50.8%。多变量分析显示，住院死亡率仅与未使用抗真菌药物和急性呼吸衰竭显著相关（P <.001）。
实体癌和血液系统恶性肿瘤患者均可发生念珠菌血症，尤其是有基础疾病的患者。总体而言，念珠菌血症相关的发病率和死亡率仍然很高。还确定未使用抗真菌药物和急性呼吸衰竭状况与住院死亡率相关。
