Health Protection, Public Health Agency, Belfast, UK.
Department of Microbiology, Kelvin Laboratories, Royal Victoria Hospital, Belfast Trust, Belfast, UK.
Mycoses. 2019 Sep;62(9):790-795. doi: 10.1111/myc.12956. Epub 2019 Jun 20.
Geographical variation is observed in invasive candida infection (ICI) and differences between critical care units (CCUs) may contribute. To examine rates, risk factors and individual and unit-level variation of ICI in UK CCUs. Data from the Fungal Infection Risk Evaluation Study was used to examine individuals admitted to 96 CCUs in the UK; July 2009-March 2011. Cases were non-neutropenic individuals aged 18 years and over with ICI identified after admission. Mixed-effects Poisson regression models adjusted for the CCU. There were 225 cases of ICI, a rate of 6.84/10 000 bed days and a threefold variation between the lowest and highest UK regions. Independent risk factors included abdominal surgery (adjusted incidence rate ratio (AIRR) 2.03 95% CI 1.49, 2.76), parenteral nutrition (AIRR 1.89 95% CI 1.33, 2.70), fungal colonisation at two or more sites (AIRR 2.30 95% CI 1.34, 3.95) and indwelling devices. Approximately 4% of the variation in ICI rates could be attributed to the CCU. We identified independent risk factors for ICI and showed, for the first time, that the critical care unit effect was small. Despite this, future studies should consider the hierarchical structure of the data to ensure robust estimates.
观察到侵袭性念珠菌感染（ICI）存在地域差异，重症监护病房（CCU）之间的差异可能是原因之一。本研究旨在调查英国 CCU 中 ICI 的发生率、危险因素以及个体和单位水平的变异性。该研究使用了来自真菌感染风险评估研究的数据，该研究纳入了 2009 年 7 月至 2011 年 3 月期间英国 96 个 CCU 中收治的年龄≥18 岁、无中性粒细胞减少的 ICI 患者。采用混合效应泊松回归模型对 CCU 进行校正。共发现 225 例 ICI 患者，发病率为 6.84/10000 床位日，英国最低和最高地区之间的发病率差异达 3 倍。独立的危险因素包括腹部手术（校正发病率比（AIRR）2.03，95%CI 1.49-2.76）、肠外营养（AIRR 1.89，95%CI 1.33-2.70）、两个或更多部位的真菌定植（AIRR 2.30，95%CI 1.34-3.95）和留置装置。大约 4%的 ICI 发病率差异可归因于 CCU。我们确定了 ICI 的独立危险因素，并首次表明 CCU 效应较小。尽管如此，未来的研究仍应考虑数据的层次结构，以确保稳健的估计。
