Reno Jessica, Doshi Saumil, Tunali Amy K, Stein Betsy, Farley Monica M, Ray Susan M, Jacob Jesse T
1Atlanta Research and Education Foundation,Decatur,Georgia.
4Emory University School of Medicine,Atlanta,Georgia. (Present affiliations: New Mexico Department of Health, Santa Fe, New Mexico [J.R.]; Howard University, Washington, DC [S.D.].
Infect Control Hosp Epidemiol. 2015 Nov;36(11):1298-304. doi: 10.1017/ice.2015.185. Epub 2015 Aug 27.
Patients with candidemia are at risk for other invasive infections, such as methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI).
To identify the risk factors for, and outcomes of, BSI in adults with Candida spp. and MRSA at the same time or nearly the same time.
Population-based cohort study.
Metropolitan Atlanta, March 1, 2008, through November 30, 2012.
All residents with Candida spp. or MRSA isolated from blood.
The Georgia Emerging Infections Program conducts active, population-based surveillance for candidemia and invasive MRSA. Medical records for patients with incident candidemia were reviewed to identify cases of MRSA coinfection, defined as incident MRSA BSI 30 days before or after candidemia. Multivariate logistic regression was performed to identify factors associated with coinfection in patients with candidemia.
Among 2,070 adult candidemia cases, 110 (5.3%) had coinfection within 30 days. Among these 110 coinfections, MRSA BSI usually preceded candidemia (60.9%; n=67) or occurred on the same day (20.0%; n=22). The incidence of coinfection per 100,000 population decreased from 1.12 to 0.53 between 2009 and 2012, paralleling the decreased incidence of all MRSA BSIs and candidemia. Thirty-day mortality was similarly high between coinfection cases and candidemia alone (45.2% vs 36.0%, P=.10). Only nursing home residence (odds ratio, 1.72 [95% CI, 1.03-2.86]) predicted coinfection.
A small but important proportion of patients with candidemia have MRSA coinfection, suggesting that heightened awareness is warranted after 1 major BSI pathogen is identified. Nursing home residents should be targeted in BSI prevention efforts.
念珠菌血症患者有发生其他侵袭性感染的风险，如耐甲氧西林金黄色葡萄球菌（MRSA）血流感染（BSI）。
确定同时或几乎同时感染念珠菌属和MRSA的成年患者发生BSI的危险因素及转归。
基于人群的队列研究。
2008年3月1日至2012年11月30日期间的佐治亚州亚特兰大市。
所有从血液中分离出念珠菌属或MRSA的居民。
佐治亚州新发感染项目对念珠菌血症和侵袭性MRSA进行主动的基于人群的监测。回顾念珠菌血症患者的病历，以确定MRSA合并感染病例，定义为念珠菌血症发生前或后30天内发生的MRSA BSI。进行多因素logistic回归分析，以确定念珠菌血症患者合并感染的相关因素。
在2070例成年念珠菌血症病例中，110例（5.3%）在30天内发生合并感染。在这110例合并感染中，MRSA BSI通常先于念珠菌血症发生（60.9%；n = 67）或在同一天发生（20.0%；n = 22）。2009年至2012年期间，每10万人口中合并感染的发生率从1.12降至0.53，与所有MRSA BSI和念珠菌血症的发生率下降趋势一致。合并感染病例和单纯念珠菌血症病例的30天死亡率相似（45.2%对36.0%，P = 0.10）。只有入住疗养院（比值比，1.72 [95%CI，1.03 - 2.86]）可预测合并感染。
一小部分但重要比例的念珠菌血症患者存在MRSA合并感染，这表明在识别出一种主要的BSI病原体后，有必要提高警惕。疗养院居民应作为BSI预防工作的重点对象。
