Infectious Disease Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Clinical Trials Coordinating Center of Istituto Toscano Tumori, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Infection. 2018 Aug;46(4):469-476. doi: 10.1007/s15010-018-1139-z. Epub 2018 Apr 13.
An early adequate antifungal therapy based on the knowledge of local epidemiology can reduce the candidemia-attributable mortality and the length of hospitalization. We performed a retrospective study to analyze the epidemiology of candidemia and the antifungal consumption in our hospital.
We analyzed Candida spp. isolated from the blood, and their susceptibility profile from 2005 to 2016 in Careggi University Hospital, Florence, Italy. We also performed a stratified analysis by clinical setting where Candida spp. were isolated (Medical Wards, Surgery, Intensive Care Unit-ICU). Then, we retrospectively reviewed the annual consumption of antifungal agents and calculated the defined daily dosing for 10,000 hospital days.
The rate of candidemia was higher in ICU than other settings and Candida albicans was the first cause of candidemia (61.2%). After adjustment for hospital days, the rate of C. albicans showed a statistically significant parabolic trend (p < 0.001), with a peak of incidence in 2010. After 2010, we observed a reduction of candidemia due to both C. albicans and non-albicans species. Between 2005 and 2015, we reported an increasing increased use of echinocandins. As far as resistance profile is concerned, only one Candida glabrata isolate was resistant to caspofungin (1.9%) and 30% of C. glabrata were resistant to fluconazole.
Our data describe C. albicans as the first cause of candidemia in all the studied settings and the low rate of echinocandin resistance, despite their increased use over the study period. ICU was confirmed as the setting with the highest incidence of candidemia.
基于当地流行病学知识，早期进行充分的抗真菌治疗可以降低念珠菌血症相关死亡率和住院时间。我们进行了一项回顾性研究，以分析我院念珠菌血症的流行病学和抗真菌药物的使用情况。
我们分析了 2005 年至 2016 年佛罗伦萨卡雷吉大学医院（Careggi University Hospital）血液中分离出的念珠菌及其药敏谱。我们还按临床科室对念珠菌分离的情况进行了分层分析（内科病房、外科、重症监护病房-ICU）。然后，我们回顾性地审查了抗真菌药物的年度使用情况，并计算了每 10000 个住院日的限定日剂量。
ICU 的念珠菌血症发生率高于其他科室，而白色念珠菌是念珠菌血症的首要病因（61.2%）。在校正住院日数后，白色念珠菌的发生率呈统计学显著的抛物线趋势（p<0.001），2010 年达到高峰。2010 年后，我们观察到白色念珠菌和非白色念珠菌念珠菌血症的发生率均有所下降。2005 年至 2015 年，我们报告了棘白菌素类药物使用量的增加。就耐药谱而言，只有 1 株光滑念珠菌对卡泊芬净耐药（1.9%），30%的光滑念珠菌对氟康唑耐药。
我们的数据表明，在所有研究环境中，白色念珠菌都是念珠菌血症的首要病因，并且棘白菌素类药物的耐药率较低，尽管在研究期间其使用量有所增加。ICU 被证实是念珠菌血症发生率最高的科室。
