Fernández-Cruz A, Cruz Menárguez M, Muñoz P, Pedromingo M, Peláez T, Solís J, Rodríguez-Créixems M, Bouza E
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,
Eur J Clin Microbiol Infect Dis. 2015 Aug;34(8):1543-9. doi: 10.1007/s10096-015-2384-z. Epub 2015 May 13.
Most current guidelines do not recommend systematic screening with echocardiography in patients with candidemia, as Candida infective endocarditis (CIE) is considered an uncommon disease. During the study period, we recommended echocardiography systematically to all candidemic patients that did not have contraindications and accepted to participate in the study. We intended to assess the incidence of unrecognized CIE in adult patients with candidemia. Our institution is a tertiary teaching hospital in which we follow all patients with candidemia. From January 2007 to October 2012, echocardiography was systematically recommended to suitable candidates. We recorded 263 cases of candidemia in adult patients. Echocardiography was not performed in 76 of these patients for the following reasons: patients had died when blood cultures became positive (17), patients were critically or terminally ill (38), or the patient or physician refused the procedure (21). The remaining 187 patients constitute the basis of this report. CIE was diagnosed in 11 cases (4.2 % of the whole candidemic population and 5.9 % of the population with echocardiographic study). The results of transthoracic echocardiography (TTE) suggested infective endocarditis (IE) in 5/172 patients (2.9 %), and the result of transesophageal echocardiography (TEE) was positive in 10/87 (11.5 %). Among 11 confirmed cases of CIE, the disease was clinically unsuspected in three patients. At least 4.2 % of all candidemic patients have CIE. CIE is frequently clinically unsuspected and echocardiography is required to demonstrate a high proportion of cases.
目前大多数指南不建议对念珠菌血症患者进行超声心动图系统筛查，因为念珠菌感染性心内膜炎（CIE）被认为是一种罕见疾病。在研究期间，我们对所有没有禁忌证且同意参与研究的念珠菌血症患者系统地推荐了超声心动图检查。我们旨在评估成年念珠菌血症患者中未被识别的CIE的发生率。我们的机构是一家三级教学医院，对所有念珠菌血症患者进行随访。从2007年1月至2012年10月，我们对合适的患者系统地推荐了超声心动图检查。我们记录了263例成年患者的念珠菌血症病例。其中76例患者未进行超声心动图检查，原因如下：血培养阳性时患者已死亡（17例）、患者病情危重或处于终末期（38例）、患者或医生拒绝该检查（21例）。其余187例患者构成本报告的基础。11例患者被诊断为CIE（占整个念珠菌血症患者群体的4.2%，占接受超声心动图检查患者群体的5.9%）。经胸超声心动图（TTE）结果提示172例患者中有5例（2.9%）存在感染性心内膜炎（IE），经食管超声心动图（TEE）结果在87例患者中有10例（11.5%）呈阳性。在11例确诊的CIE病例中，有3例患者临床上未被怀疑患有该病。所有念珠菌血症患者中至少4.2%患有CIE。CIE在临床上常常未被怀疑，需要超声心动图检查来发现相当比例的病例。
