Ding Xiurong, Yan Donghui, Sun Wei, Zeng Zhaoyin, Su Ruirui, Su Jianrong
Department of Clinical Laboratory, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China.
Clinical Laboratory Center, Beijing Friendship Hospital, Capital Medical University, Beijing100050, China.
Med Mycol. 2015 Sep;53(7):684-90. doi: 10.1093/mmy/myv060. Epub 2015 Jul 30.
Nosocomial candidemia extends the length of hospital stay, increases the costs of medical care, and is associated with a high mortality rate. Epidemiological data that assist in the choice of initial therapy may help to improve the prognosis. The present study was undertaken to investigate the epidemiology of nosocomial candidemia and identify risk factors for nosocomial candidemia caused by C. albicans and non-albicans Candida species (NAC). A retrospective chart review was undertaken to analyze cases of nosocomial candidemia treated at the Beijing Friendship Hospital between January 2008 and December 2012. All cases of candidemia were identified using the previously published criteria. Among 106 patients analyzed, 53.8% had nosocomial candidemia caused by NAC. Candida albicans was the most common causative agent, accounting for 46.2% of all cases, followed by C. glabrata (25.5%), C. tropicalis (15.1%), C. parapsilosis (10.4%) and C. Krusei (0.9%). Comparison of nosocomial C. albicans and NAC candidemia by multivariate logistic regression showed that factors independently associated with nosocomial NAC candidemia included exposure to azole agents (odds ratio [OR]: 3.359; 95% confidence interval [CI]: 1.136-10.154; P = .031) and artificial surgical implants (OR: 37.519; 95% CI: 2.5-562.998; P = .009). A significant risk factor for nosocomial C. albicans candidemia was cancer surgery (OR: 0.075; 95% CI: 0.013-0.437; P = .004). Clinical and epidemiological differences in the risk factors between nosocomial candidemia caused by C. albicans and NAC should be considered when selecting an initial antifungal regimen for the treatment of adult patients. This should be undertaken before the availability of species identification and/or antifungal susceptibility results.
医院获得性念珠菌血症会延长住院时间，增加医疗费用，并与高死亡率相关。有助于选择初始治疗方案的流行病学数据可能有助于改善预后。本研究旨在调查医院获得性念珠菌血症的流行病学，并确定由白色念珠菌和非白色念珠菌（NAC）引起的医院获得性念珠菌血症的危险因素。进行了一项回顾性病历审查，以分析2008年1月至2012年12月在北京友谊医院接受治疗的医院获得性念珠菌血症病例。所有念珠菌血症病例均根据先前公布的标准进行鉴定。在分析的106例患者中，53.8%的患者患有由NAC引起的医院获得性念珠菌血症。白色念珠菌是最常见的病原体，占所有病例的46.2%，其次是光滑念珠菌（25.5%）、热带念珠菌（15.1%）、近平滑念珠菌（10.4%）和克柔念珠菌（0.9%）。通过多因素logistic回归比较医院获得性白色念珠菌血症和NAC念珠菌血症，结果显示与医院获得性NAC念珠菌血症独立相关的因素包括使用唑类药物（比值比[OR]：3.359；95%置信区间[CI]：1.136 - 10.154；P = 0.031）和人工外科植入物（OR：37.519；95%CI：2.5 - 562.998；P = 0.009）。医院获得性白色念珠菌血症的一个显著危险因素是癌症手术（OR：0.075；95%CI：0.013 - 0.437；P = 0.004）。在为成年患者选择初始抗真菌治疗方案时，应考虑白色念珠菌和NAC引起的医院获得性念珠菌血症危险因素的临床和流行病学差异。这应在获得菌种鉴定和/或抗真菌药敏结果之前进行。
