Kofteridis Diamantis P, Valachis Antonis, Dimopoulou Dimitra, Andrianaki Angeliki M, Christidou Athanasia, Maraki Sofia, Spernovasilis Nikolaos A, Samonis George
Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, 71 110, Heraklion, Crete, Greece.
Department of Oncology, Mälarsjukhuset, Eskilstuna, Sweden.
Mycopathologia. 2017 Aug;182(7-8):665-672. doi: 10.1007/s11046-017-0146-4. Epub 2017 May 19.
The study identified factors predisposing to non-albicans candidemia with special interest to prior antimicrobial treatment. A retrospective, case-case-control study was performed at the University Hospital of Heraklion, Greece, from November 2007 through September 2011 including adult patients. The study had three groups. The first included 58 patients with non-albicans candidemia, the second 48 with C. albicans candidemia, while the third (control) 104 without candidemia. Each of the two candidemia groups was compared with the control using multivariate logistic regression model. The mean (SD) age of the non-albicans, the albicans and the control patients was 67 (12), 67 (18) and 59 (19) years, respectively. The most common non-albicans Candida spp. isolated were C. parapsilosis in 19 patients (33%), C. glabrata in 17 (29%) and C. tropicalis in 15 (26%). Independent risk factors for non-albicans candidemia were prior treatment with quinolones (p < 0.001), b-lactam-b-lactamase inhibitors (p = 0.011) and presence of central venous catheter (p = 0.05), while for C. albicans candidemia were prior treatment with quinolones (p < 0.001), carbapenems (p = 0.003) along with cardiac disease (p < 0.001). Neither duration of hospitalization nor in-hospital mortality [41% for the non-albicans vs 29% for C. albicans group (p = 0.192)] was significantly different between the two candidemia groups. The study reveals the role of antimicrobial exposure as a risk factor for candidemia caused by different species. Prior treatment with b-lactam-b-lactamase inhibitors was associated with non-albicans, while with carbapenems with C. albicans candidemia. Prior use of quinolones was associated with candidemia in general.
该研究确定了非白色念珠菌血症的易感因素，尤其关注既往抗菌治疗情况。2007年11月至2011年9月在希腊伊拉克利翁大学医院对成年患者进行了一项回顾性病例-病例对照研究。该研究有三组。第一组包括58例非白色念珠菌血症患者，第二组48例白色念珠菌血症患者，第三组（对照组）104例无念珠菌血症患者。使用多因素逻辑回归模型将两个念珠菌血症组分别与对照组进行比较。非白色念珠菌血症组、白色念珠菌血症组和对照组患者的平均（标准差）年龄分别为67（12）岁、67（18）岁和59（19）岁。分离出的最常见非白色念珠菌菌种为近平滑念珠菌19例（33%）、光滑念珠菌17例（29%）和热带念珠菌15例（26%）。非白色念珠菌血症的独立危险因素为既往使用喹诺酮类药物（p<0.001）、β-内酰胺-β-内酰胺酶抑制剂（p=0.011）以及存在中心静脉导管（p=0.05），而白色念珠菌血症的危险因素为既往使用喹诺酮类药物（p<0.001）、碳青霉烯类药物（p=0.003）以及患有心脏病（p<0.001）。两个念珠菌血症组之间的住院时间和院内死亡率[非白色念珠菌血症组为41%，白色念珠菌血症组为29%（p=0.192）]均无显著差异。该研究揭示了抗菌药物暴露作为不同菌种引起念珠菌血症的危险因素的作用。既往使用β-内酰胺-β-内酰胺酶抑制剂与非白色念珠菌血症相关，而与碳青霉烯类药物相关的是白色念珠菌血症。既往使用喹诺酮类药物总体上与念珠菌血症相关。
