Murri R, Scoppettuolo G, Ventura G, Fabbiani M, Giovannenze F, Taccari F, Milozzi E, Posteraro B, Sanguinetti M, Cauda R, Fantoni M
Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
Institute of Public Health, Section of Hygiene, Catholic University of Rome, Rome, Italy.
Eur J Clin Microbiol Infect Dis. 2016 Feb;35(2):187-93. doi: 10.1007/s10096-015-2527-2. Epub 2015 Dec 3.
The incidence of Candida bloodstream infections (BSIs) has increased over time, especially in medical wards. The objective of this study was to evaluate the impact of different antifungal treatment strategies on 30-day mortality in patients with Candida BSI not admitted to intensive care units (ICUs) at disease onset. This prospective, monocentric, cohort study was conducted at an 1100-bed university hospital in Rome, Italy, where an infectious disease consultation team was implemented. All cases of Candida BSIs observed in adult patients from November 2012 to April 2014 were included. Patients were grouped according to the initial antifungal strategy: fluconazole, echinocandin, or liposomal amphotericin B. Cox regression analysis was used to identify risk factors significantly associated with 15-day and 30-day mortality. During the study period, 130 patients with candidemia were observed (58 % with C. albicans, 7 % with C. glabrata, and 23 % with C. parapsilosis). The first antifungal drug was fluconazole for 40 % of patients, echinocandin for 57.0 %, and liposomal amphotericin B for 4 %. During follow-up, 33 % of patients died. The cumulative mortality 30 days after the candidemia episode was 30.8 % and was similar among groups. In the Cox regression analysis, clinical presentation was the only independent factor associated with 15-day mortality, and Acute Physiology and Chronic Health Evaluation (APACHE) II score and clinical presentation were the independent factors associated with 30-day mortality. No differences in 15-day and 30-day mortality were observed between patients with and without C. albicans candidemia. In patients with candidemia admitted to medical or surgical wards, clinical severity but not the initial antifungal strategy were significantly correlated with mortality.
随着时间的推移，念珠菌血流感染（BSIs）的发病率有所上升，尤其是在医疗病房。本研究的目的是评估不同抗真菌治疗策略对疾病发作时未入住重症监护病房（ICU）的念珠菌BSI患者30天死亡率的影响。这项前瞻性、单中心队列研究在意大利罗马一家拥有1100张床位的大学医院进行，该医院设有传染病咨询团队。纳入了2012年11月至2014年4月期间在成年患者中观察到的所有念珠菌BSIs病例。患者根据初始抗真菌策略分组：氟康唑、棘白菌素或脂质体两性霉素B。采用Cox回归分析来确定与15天和30天死亡率显著相关的危险因素。在研究期间，观察到130例念珠菌血症患者（58%为白色念珠菌，7%为光滑念珠菌，23%为近平滑念珠菌）。40%的患者首剂抗真菌药物为氟康唑，57.0%为棘白菌素，4%为脂质体两性霉素B。在随访期间，33%的患者死亡。念珠菌血症发作后30天的累积死亡率为30.8%，各治疗组之间相似。在Cox回归分析中，临床表现是与15天死亡率相关的唯一独立因素，急性生理与慢性健康状况评估（APACHE）II评分和临床表现是与30天死亡率相关的独立因素。白色念珠菌血症患者与非白色念珠菌血症患者在15天和30天死亡率方面未观察到差异。在入住内科或外科病房的念珠菌血症患者中，临床严重程度而非初始抗真菌策略与死亡率显著相关。
