Infectious Diseases Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Institute for Clinical Microbiology and Hygiene, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Infection. 2020 Apr;48(2):275-284. doi: 10.1007/s15010-020-01393-9. Epub 2020 Feb 12.
The aim of this study was to analyse temporal changes in the epidemiology of candidemia assessing patient's characteristics, risk factors, diagnostic management, treatment, and outcome in a tertiary care hospital in South Eastern Germany.
In this retrospective cohort study patients with blood cultures positive for Candida spp. were identified from the microbiological database in the years 2006-2018. A detailed collection of patients' characteristics was obtained for the time periods 2006-2008 and 2016-2018. Risk factors for survival were analysed in a logistic regression analysis.
In the years 2006-2018, a total of 465 episodes of candidemia were identified. An increase in candidemia cases was evident in the period of 2016-2018 compared to 2006-2015 and to 2006-2008 in absolute numbers and adjusted to patient-days. C. albicans was responsible for 62.8% of cases in 2006-2008 and 51.2% of all cases in the years 2016-2018, respectively, whereas there was a significant increase of C. glabrata in the latter period (16.3-31.5%). Overall mortality was not significantly different in the two periods. Infectious diseases consultation led to a lower mortality of patients with candidemia and to a higher adherence to guidelines. In multivariate analysis, only complete change or extraction of intravascular indwelling material and female gender were independent predictors for survival.
We observed an increase in candidemia rates and rates of non-albicans spp. over time. A complete change of all catheters and/or indwelling devices improved survival. ID consultation led to a better guideline adherence.
本研究旨在分析念珠菌血症的流行病学变化，评估德国东南部一家三级护理医院患者的特征、危险因素、诊断管理、治疗和预后。
在这项回顾性队列研究中，从 2006 年至 2018 年的微生物数据库中确定血液培养阳性为念珠菌属的患者。为 2006 年至 2008 年和 2016 年至 2018 年的时间段详细收集患者特征。使用逻辑回归分析确定生存的危险因素。
在 2006 年至 2018 年期间，共发现 465 例念珠菌血症病例。与 2006 年至 2008 年相比，2016 年至 2018 年念珠菌血症病例绝对数量和按患者天数调整后均有所增加。在 2006 年至 2008 年，C. albicans 占病例的 62.8%，而在 2016 年至 2018 年所有病例中占 51.2%，而后者 C. glabrata 的比例显著增加（16.3-31.5%）。两个时期的总死亡率无显著差异。感染性疾病咨询可降低念珠菌血症患者的死亡率并提高对指南的依从性。多变量分析显示，只有血管内留置物的完全更换或拔出以及女性是生存的独立预测因素。
我们观察到念珠菌血症发生率和非白念珠菌属发生率随时间增加。所有导管和/或留置装置的完全更换可提高生存率。ID 咨询可提高对指南的依从性。
