Kato Hideaki, Yoshimura Yukihiro, Suido Yoshihiro, Shimizu Hiroyuki, Ide Kazuo, Sugiyama Yoshifumi, Matsuno Kasumi, Nakajima Hideaki
Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama 240-8555, Japan.
J Infect Chemother. 2019 May;25(5):341-345. doi: 10.1016/j.jiac.2019.01.002. Epub 2019 Feb 2.
Candida blood stream infection (candidemia) is severe systemic infection mainly develops after intensive medical cares. The mortality of candidemia is affected by the underlying conditions, causative agents and the initial management. We retrospectively analyzed mortality-related risk factors in cases of candidemia between April 2011 and March 2016 in five regional hospitals in Japan. We conducted bivariate and multivariate analysis of factors including causative Candida species, patients' predisposing conditions, and treatment strategies, such as empirically selected antifungal drug and time to appropriate antifungal treatment, to elucidate their effects on 30-day mortality. The study enrolled 289 cases of candidemia in adults. Overall 30-day mortality was 27.7%. Forty-nine cases (17.0%) were community-acquired. Bivariate analysis found advanced age, high Sequential Organ Failure Assessment (SOFA) score, and prior antibiotics use as risk factors for high mortality; however community-acquired candidemia, C. parapsilosis candidemia, obtaining follow-up blood culture, and empiric treatment with fluconazole were associated with low mortality. Logistic regression revealed age ≥65 years (adjusted odds ratio, 2.13) and sequential organ failure assessment (SOFA) score ≥6 (6.30) as risk factors for 30-day mortality. In contrast, obtaining follow-up blood culture (0.38) and empiric treatment with fluconazole (0.32) were found to be protective factors. The cases with candidemia in associated with advanced age and poor general health conditions should be closely monitored. Obtaining follow-up blood culture contributed to an improved prognosis.
念珠菌血流感染（念珠菌血症）是一种严重的全身感染，主要发生在重症监护之后。念珠菌血症的死亡率受基础疾病、病原体和初始治疗的影响。我们回顾性分析了2011年4月至2016年3月期间日本五家地区医院念珠菌血症病例中与死亡率相关的危险因素。我们对包括致病念珠菌种类、患者的易感因素以及治疗策略（如经验性选择的抗真菌药物和开始适当抗真菌治疗的时间）等因素进行了二元和多变量分析，以阐明它们对30天死亡率的影响。该研究纳入了289例成人念珠菌血症病例。总体30天死亡率为27.7%。49例（17.0%）为社区获得性感染。二元分析发现高龄、高序贯器官衰竭评估（SOFA）评分和先前使用抗生素是高死亡率的危险因素；然而，社区获得性念珠菌血症、近平滑念珠菌血症、进行随访血培养以及氟康唑经验性治疗与低死亡率相关。逻辑回归显示年龄≥65岁（调整后的优势比为2.13）和序贯器官衰竭评估（SOFA）评分≥6（6.30）是30天死亡率的危险因素。相比之下，进行随访血培养（0.38）和氟康唑经验性治疗（0.32）被发现是保护因素。对于伴有高龄和一般健康状况较差的念珠菌血症病例应密切监测。进行随访血培养有助于改善预后。
