Teo Jocelyn Qi-Min, Candra Samuel Rocky, Lee Shannon Jing-Yi, Chia Shannon Yu-Hng, Leck Hui, Tan Ai-Ling, Neo Hui-Peng, Leow Kenneth Wei-Liang, Cai Yiying, Ee Pui Lai Rachel, Lim Tze-Peng, Lee Winnie, Kwa Andrea Lay-Hoon
Department of Pharmacy, Singapore General Hospital, Blk 8 Level 2, Outram Road, Singapore, 169608 Singapore.
Present address: Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore.
Antimicrob Resist Infect Control. 2017 Mar 11;6:27. doi: 10.1186/s13756-017-0184-1. eCollection 2017.
Candidemia is a common cause of nosocomial bloodstream infections, resulting in high morbidity and mortality. This study was conducted to describe the epidemiology, species distribution, antifungal susceptibility patterns and outcomes of candidemia in a large regional tertiary referral hospital.
A retrospective surveillance study of patients with candidemia was conducted at Singapore General Hospital between July 2012 and December 2015. In addition, incidence densities and species distribution of candidemia episodes were analysed from 2008 to 2015.
In the period of 2012 to 2015, 261 candidemia episodes were identified. The overall incidence was 0.14/1000 inpatient-days. (31.4%), (29.9%), and (23.8%) were most commonly isolated. The incidence of significantly increased from 2008 to 2015 (Coefficient 0.004, confidence interval 0-0.007, = 0.04). Fluconazole resistance was detected primarily in (16.7%) and (7.2%). mutations were identified in one and one . Candidemia episodes caused by were more commonly encountered in patients with haematological malignancies ( = 0.01), neutropenia ( < 0.001) and higher SAPS II scores ( = 0.02), while prior exposure to echinocandins was associated with isolation of ( = 0.001). Echinocandins (73.3%) were most commonly prescribed as initial treatment. The median (range) time to initial treatment was 1 (0-9) days. The 30-day in-hospital mortality rate was 49.8%. High SAPS II score (Odds ratio, OR 1.08; 95% confidence interval, CI 1.05-1.11) and renal replacement therapy (OR 5.54; CI 2.80-10.97) were independent predictors of mortality, while drain placement (OR 0.44; CI 0.19-0.99) was protective.
Decreasing azole susceptibilities to and the emergence of echinocandin resistance suggest that susceptibility patterns may no longer be sufficiently predicted by speciation in our institution. Candidemia is associated with poor outcomes. Strategies optimising antifungal therapy, especially in the critically-ill population, should be explored.
念珠菌血症是医院血流感染的常见原因，会导致高发病率和死亡率。本研究旨在描述一家大型区域三级转诊医院念珠菌血症的流行病学、菌种分布、抗真菌药敏模式及转归情况。
2012年7月至2015年12月在新加坡总医院对念珠菌血症患者进行了一项回顾性监测研究。此外，分析了2008年至2015年念珠菌血症发作的发病率密度和菌种分布。
2012年至2015年期间，共识别出261例念珠菌血症发作。总体发病率为0.14/1000住院日。白色念珠菌（31.4%）、热带念珠菌（29.9%）和光滑念珠菌（23.8%）是最常分离出的菌种。从2008年到2015年，光滑念珠菌的发病率显著增加（系数0.004，置信区间0 - 0.007，P = 0.04）。氟康唑耐药主要在光滑念珠菌（16.7%）和近平滑念珠菌（7.2%）中检测到。在一株光滑念珠菌和一株近平滑念珠菌中鉴定出了FKS突变。由光滑念珠菌引起的念珠菌血症发作在血液系统恶性肿瘤患者（P = 0.01）、中性粒细胞减少患者（P < 0.001）和较高的简化急性生理学评分II（SAPS II）患者中更常见（P = 0.02），而先前使用棘白菌素与光滑念珠菌的分离有关（P = 0.001）。棘白菌素（73.3%）是最常作为初始治疗使用的药物。初始治疗的中位（范围）时间为1（0 - 9）天。30天院内死亡率为49.8%。高SAPS II评分（比值比，OR 1.08；95%置信区间，CI 1.05 - 1.11）和肾脏替代治疗（OR 5.54；CI 2.80 - 10.97）是死亡率的独立预测因素，而放置引流管（OR 0.44；CI 0.19 - 0.99）具有保护作用。
唑类对光滑念珠菌和近平滑念珠菌的敏感性降低以及棘白菌素耐药的出现表明，在我们的机构中，药敏模式可能不再能通过菌种充分预测。念珠菌血症与不良转归相关。应探索优化抗真菌治疗的策略，尤其是在危重症人群中。
Zotero 插件