Yoshino Yusuke, Wakabayashi Yoshitaka, Suzuki Satoshi, Seo Kazunori, Koga Ichiro, Kitazawa Takatoshi, Okugawa Shu, Ota Yasuo
Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan.
Singapore Med J. 2014 Nov;55(11):579-82. doi: 10.11622/smedj.2014154.
Early detection of catheter-related candidemia is necessary to ensure that patients receive prompt and appropriate treatment. The aim of the present case-control study is to investigate the clinical features of catheter-related candidemia at disease onset, so as to determine the clinical indications for empiric antifungal therapy.
All 41 cases of catheter-related candidemia from September 2009 to August 2011 at a teaching hospital were included in the present study. To determine the characteristics that were risk factors for developing catheter-related candidemia, we compared all cases of catheter-related candidemia with all 107 cases of catheter-related blood stream infection (CRBSI) caused by non-Candida spp.
In comparison with CRBSI due to non-Candida spp., the duration of catheter use was significantly longer in cases of catheter-related candidemia (13.9 ± 9.0 days vs. 23.2 ± 25.2 days). There was also a significant difference in the frequency of pre-antibiotic treatment between catheter-related candidemia and CRBSI due to non-Candida spp. (97.6% [40/41 cases] vs. 44.9% [48/107 cases]). Patients with catheter-related candidemia also had significantly more severe clinical statuses (measured using the Sepsis-related Organ Failure Assessment score) than patients with CRBSI due to non-Candida spp. (7.63 ± 3.65 vs. 5.92 ± 2.81).
When compared to patients with CRBSI caused by non-Candida spp., patients with catheter-related candidemia had significantly more severe clinical backgrounds, longer duration of catheter use and more frequent prior administration of antibiotic agents.
早期发现导管相关念珠菌血症对于确保患者获得及时且恰当的治疗至关重要。本病例对照研究的目的是调查导管相关念珠菌血症发病时的临床特征，以便确定经验性抗真菌治疗的临床指征。
本研究纳入了2009年9月至2011年8月在一家教学医院发生的所有41例导管相关念珠菌血症病例。为确定发生导管相关念珠菌血症的危险因素特征，我们将所有导管相关念珠菌血症病例与所有107例由非念珠菌属引起的导管相关血流感染（CRBSI）病例进行了比较。
与非念珠菌属引起的CRBSI相比，导管相关念珠菌血症病例的导管使用时间显著更长（13.9±9.0天对23.2±25.2天）。导管相关念珠菌血症与非念珠菌属引起的CRBSI之间在抗生素治疗前的频率方面也存在显著差异（97.6%[40/41例]对44.9%[48/107例]）。导管相关念珠菌血症患者的临床状况（使用脓毒症相关器官功能衰竭评估评分衡量）也比非念珠菌属引起的CRBSI患者严重得多（7.63±3.65对5.92±2.81）。
与非念珠菌属引起的CRBSI患者相比，导管相关念珠菌血症患者的临床背景显著更严重，导管使用时间更长，且先前使用抗生素的频率更高。
