外科重症监护病房侵袭性念珠菌病的流行病学：一项观察性研究。
Epidemiology of invasive candidiasis in a surgical intensive care unit: an observational study.
作者信息
Aguilar Gerardo, Delgado Carlos, Corrales Isabel, Izquierdo Ana, Gracia Estefanía, Moreno Tania, Romero Esther, Ferrando Carlos, Carbonell José A, Borrás Rafael, Navarro David, Belda F Javier
机构信息
Surgical Intensive Care Unit, Department of Anesthesiology and Intensive Care, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain.
Department of Microbiology, Hospital Clínico Universitario de Valencia, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain.
出版信息
BMC Res Notes. 2015 Sep 29;8:491. doi: 10.1186/s13104-015-1458-4.
BACKGROUND
Invasive candidiasis (IC) is a frequent and life-threatening infection in critically ill patients. The aim of this study was to evaluate the epidemiology of IC and the antifungal susceptibility of etiological agents in patients admitted to our surgical intensive care unit (SICU) in Spain.
METHODS
We designed a prospective, observational, single center, population-based study in a SICU. We included all consecutive adult patients (≥18 years old) who had documented IC, either on admission or during their stay, between January 2012 and December 2013.
RESULTS
There were a total of 22 episodes of IC in the 1149 patients admitted during the 24-month study. The overall IC incidence was 19.1 cases per 1000 admissions. Thirteen cases of IC (59.1%) were intra-abdominal candidiasis (IAC) and 9 (40.9%) were candidemias. All cases of IAC were patients with secondary peritonitis and severe sepsis or septic shock. The overall crude mortality rate was 13.6%; while, it was 33% in patients with candidemia. All patients with IAC survived, including one patient with concomitant candidemia. The most common species causing IC was Candida albicans (13; 59.1%) followed by Candida parapsilosis (5; 22.7%), and Candida glabrata (2; 9.1%). There was also one case each (4.5%) of Candida krusei and Candida tropicalis. Thus, the ratio of non-C. albicans (9) to C. albicans (13) was 1:1.4. There was resistance to fluconazole and itraconazole in 13.6% of cases. Resistance to other antifungals was uncommon.
CONCLUSIONS
Candida parapsilosis was the second most common species after C. albicans, indicating the high prevalence of non-C. albicans species in the SICU. Resistance to azoles, particularly fluconazole, should be considered when starting an empirical treatment. Although IAC is a very frequent form of IC in critically ill surgical patients, prompt antifungal therapy and adequate source control appears to lead to a good outcome. However, our results are closely related to our ICU and any generalization must be taken with caution. Therefore, further investigations are needed.
背景
侵袭性念珠菌病（IC）在重症患者中是一种常见且危及生命的感染。本研究旨在评估西班牙我院外科重症监护病房（SICU）收治患者中IC的流行病学情况以及病原体的抗真菌药敏性。
方法
我们在一个SICU设计了一项前瞻性、观察性、单中心、基于人群的研究。纳入了2012年1月至2013年12月期间所有在入院时或住院期间记录有IC的连续成年患者（≥18岁）。
结果
在为期24个月的研究期间收治的1149例患者中，共有22例IC发作。IC的总体发病率为每1000例入院患者中有19.1例。13例IC（59.1%）为腹腔念珠菌病（IAC），9例（40.9%）为念珠菌血症。所有IAC病例均为继发性腹膜炎且伴有严重脓毒症或脓毒性休克的患者。总体粗死亡率为13.6%；而念珠菌血症患者的死亡率为33%。所有IAC患者均存活，包括1例合并念珠菌血症的患者。引起IC最常见的菌种是白色念珠菌（13例；59.1%），其次是近平滑念珠菌（5例；22.7%）和光滑念珠菌（2例；9.1%）。克柔念珠菌和热带念珠菌各有1例（4.5%）。因此，非白色念珠菌（9例）与白色念珠菌（13例）的比例为1:1.4。13.6%的病例对氟康唑和伊曲康唑耐药。对其他抗真菌药物耐药并不常见。
结论
近平滑念珠菌是仅次于白色念珠菌的第二常见菌种，表明SICU中非白色念珠菌菌种的高流行率。在开始经验性治疗时应考虑对唑类药物，尤其是氟康唑的耐药性。虽然IAC是重症外科患者中IC非常常见的一种形式，但及时的抗真菌治疗和充分的源头控制似乎能带来良好的预后。然而，我们的结果与我们的ICU密切相关，任何推广都必须谨慎。因此，需要进一步的研究。
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