Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.
Parasitology and Mycology laboratory, AP-HP, Hôpital Saint-Louis, Paris, France.
Mycoses. 2019 Mar;62(3):237-246. doi: 10.1111/myc.12872. Epub 2018 Dec 18.
Patients with extensive burns are at risk of developing candidemia.
To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients.
Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed.
Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38-68)%, SAPSII of 43 (36-58) and ABSI of 11 (8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056).
Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.
大面积烧伤患者有发生念珠菌血症的风险。
确定危重症烧伤患者念珠菌血症的潜在可改变危险因素和结局。
回顾性匹配队列研究纳入成年烧伤患者。念珠菌血症患者与发生念珠菌定植和脓毒症或感染性休克但无念珠菌血症的烧伤患者按照 1:3 的比例（相同严重程度评分和定植指数）进行匹配。进行单变量和多变量回归分析。
在 130 例有念珠菌定植且至少发生过一次脓毒症或感染性休克的严重烧伤患者中，有 14 例被诊断为念珠菌血症。在念珠菌血症组中，患者的总烧伤面积（TBSA）中位数（IQR）为 57%（38%68%），SAPSII 为 43（36%58%），ABSII 为 11（8~13）。多变量回归分析显示，只有先前使用抗生素的时间与念珠菌血症独立相关。念珠菌血症组 ICU 死亡率更高（71%比 35%[P=0.02]）。比较经验性治疗与针对性治疗的念珠菌血症患者 28 天死亡率的对数秩检验未达到显著水平（P=0.056）。
近期接受抗生素治疗的烧伤患者发生念珠菌血症的风险更高。在本系列中，抗真菌策略并未影响结局。
