Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Microbiology Section, Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2015 Oct;48(5):552-8. doi: 10.1016/j.jmii.2014.07.007. Epub 2014 Oct 12.
Candida parapsilosis is an emerging non-albicans Candida that is associated with central line-associated infection. C. parapsilosis has higher minimal inhibitory concentration to echinocandin than Candida albicans, and the effects of echinocandin on C. parapsilosis are ambiguous. Therefore, in this study, we aimed to investigate the susceptibility and the correlation between incidence and drug consumption.
This retrospective study was conducted in a tertiary teaching hospital in northern Taiwan between 2008 and 2012. The Candida species distribution, the correlation between the use of antifungal agents and the incidence of C. parapsilosis bloodstream infection, demographic information, clinical characteristics, mortality rate, and in vitro susceptibility of C. parapsilosis were analyzed.
A total of 77 episodes from 77 patients were included for analysis. The overall 90-day mortality rate was 41.6%. The incidence of C. parapsilosis bloodstream infection showed a moderate positive correlation with the increased defined daily dose of echinocandin. The risk factors associated with mortality included malignancy or a metastatic tumor. Multivariate logistical regression analysis showed that patients with malignancy had higher odds ratios in terms of mortality. The rate of C. parapsilosis resistance to fluconazole was 3%, whereas the susceptibility rate was 95.5%.
Underlying comorbidity and malignancy were factors leading to death in patients with C. parapsilosis bloodstream infection. Catheter removal did not influence the mortality rate. The survival rate of patients receiving echinocandin was lower than the group receiving fluconazole. Fluconazole remains the drug of choice to treat C. parapsilosis bloodstream infections.
近平滑念珠菌是一种新兴的非白念珠菌属念珠菌，与中心静脉相关感染有关。近平滑念珠菌对棘白菌素的最小抑菌浓度（MIC）高于白念珠菌，棘白菌素对近平滑念珠菌的作用尚不清楚。因此，本研究旨在探讨其药敏性以及发病率与药物消耗之间的相关性。
本回顾性研究于 2008 年至 2012 年在台湾北部的一家三级教学医院进行。分析了念珠菌属的分布、抗真菌药物的使用与近平滑念珠菌血流感染发病率之间的相关性、人口统计学信息、临床特征、死亡率以及近平滑念珠菌的体外药敏性。
共纳入 77 例 77 例患者的 77 个感染部位进行分析。总的 90 天死亡率为 41.6%。近平滑念珠菌血流感染的发病率与棘白菌素的定义日剂量（DDD）增加呈中度正相关。与死亡率相关的危险因素包括恶性肿瘤或转移性肿瘤。多变量逻辑回归分析显示，恶性肿瘤患者的死亡风险比更高。对氟康唑耐药的近平滑念珠菌比例为 3%，而敏感性比例为 95.5%。
基础合并症和恶性肿瘤是导致近平滑念珠菌血流感染患者死亡的因素。导管去除并未影响死亡率。接受棘白菌素治疗的患者的生存率低于接受氟康唑治疗的患者。氟康唑仍是治疗近平滑念珠菌血流感染的首选药物。
