Falcone M, Tiseo G, Tascini C, Russo A, Sozio E, Raponi G, Rosin C, Pignatelli P, Carfagna P, Farcomeni A, Luzzati R, Violi F, Menichetti F, Venditti M
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.
Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy.
Eur J Intern Med. 2017 Jun;41:33-38. doi: 10.1016/j.ejim.2017.03.005. Epub 2017 Mar 15.
An increasing prevalence of candidemia has been reported in Internal Medicine wards (IMWs). The aim of our study was to identify risk factors for candidemia among non-neutropenic patients hospitalized in IMWs.
A multicenter case-control study was performed in three hospitals in Italy. Patients developing candidemia (cases) were compared to patients without candidemia (controls) matched by age, time of admission and duration of hospitalization. A logistic regression analysis identified risk factors for candidemia, and a new risk score was developed. Validation was performed on an external cohort of patients.
Overall, 951 patients (317 cases of candidemia and 634 controls) were included in the derivation cohort, while 270 patients (90 patients with candidemia and 180 controls) constituted the validation cohort. Severe sepsis or septic shock, recent Clostridium difficile infection, diabetes mellitus, total parenteral nutrition, chronic obstructive pulmonary disease, concomitant intravenous glycopeptide therapy, presence of peripherally inserted central catheter, previous antibiotic therapy and immunosuppressive therapy were factors independently associated with candidemia. The new risk score showed good area under the curve (AUC) values in both derivation (AUC 0.973 95% CI 0.809-0.997, p<0.001) and validation cohort (0.867 95% CI 0.710-0.931, p<0.001). A threshold of 3 leads to a sensitivity of 87% and a specificity of 83%.
Non-neutropenic patients admitted in IMWs have peculiar risk factors for candidemia. A new risk score with a good performance could facilitate the identification of candidates to early antifungal therapy.
据报道，内科病房（IMW）念珠菌血症的患病率呈上升趋势。我们研究的目的是确定入住IMW的非中性粒细胞减少患者念珠菌血症的危险因素。
在意大利的三家医院进行了一项多中心病例对照研究。将发生念珠菌血症的患者（病例组）与未发生念珠菌血症的患者（对照组）按年龄、入院时间和住院时间进行匹配。通过逻辑回归分析确定念珠菌血症的危险因素，并制定了一个新的风险评分。在外部患者队列中进行了验证。
总体而言，推导队列纳入了951例患者（317例念珠菌血症患者和634例对照），而验证队列由270例患者组成（90例念珠菌血症患者和180例对照）。严重脓毒症或脓毒性休克、近期艰难梭菌感染、糖尿病、全胃肠外营养、慢性阻塞性肺疾病、同时进行静脉糖肽治疗、存在外周静脉穿刺中心静脉导管、既往抗生素治疗和免疫抑制治疗是与念珠菌血症独立相关的因素。新的风险评分在推导队列（AUC 0.973，95%CI 0.809-0.997，p<0.001）和验证队列（0.867，95%CI 0.710-0.931，p<0.001）中均显示出良好的曲线下面积（AUC）值。阈值为3时，敏感性为87%，特异性为83%。
入住IMW的非中性粒细胞减少患者有念珠菌血症的特殊危险因素。一个性能良好的新风险评分有助于识别早期抗真菌治疗的候选者。
