Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China.
Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
BMJ Open. 2020 Jul 12;10(7):e036452. doi: 10.1136/bmjopen-2019-036452.
This study aimed to evaluate the duration of intensive care unit (ICU) stay prior to onset of invasive candidiasis (IC)/candidaemia.
Systematic review and meta-analysis.
PubMed, Cochrane, Embase and Web of Science databases were searched through June 2019 to identify relevant studies.
Adult patients who had been admitted to the ICU and developed an IC infection.
The following data were extracted from each article: length of hospital stay, length of ICU stay, duration of ICU admission prior to candidaemia onset, percentage of patients who received antibiotics and duration of their antibiotic therapy prior to candidaemia onset, and overall mortality. In addition to the traditional meta-analyses, meta-regression was performed to explore possible mediators which might have contributed to the heterogeneity.
The mean age of patients ranged from 28 to 76 years across selected studies. The pooled mean duration of ICU admission before onset of candidaemia was 12.9 days (95% CI 11.7 to 14.2). The pooled mean duration of hospital stay was 36.3±5.3 days (95% CI 25.8 to 46.7), and the pooled mean mortality rate was 49.3%±2.2% (95% CI 45.0% to 53.5%). There was no significant difference in duration of hospital stay (p=0.528) or overall mortality (p=0.111), but a significant difference was observed in the mean length of ICU stay (2.8 days, p<0.001), between patients with and without . Meta-regression analysis found that South American patients had longer duration of ICU admission prior to candidaemia onset than patients elsewhere, while those in Asia had the shortest duration.
Patients with IC are associated with longer ICU stay, with the shortest duration of ICU admission prior to the candidaemia onset in Asia. This shows a more proactive strategy in the diagnosis of IC should be considered in caring for ICU patients.
本研究旨在评估侵袭性念珠菌病（IC）/念珠菌血症发病前入住重症监护病房（ICU）的时间。
系统回顾和荟萃分析。
通过 2019 年 6 月检索 PubMed、Cochrane、Embase 和 Web of Science 数据库，以确定相关研究。
入住 ICU 并发生 IC 感染的成年患者。
从每篇文章中提取以下数据：住院时间、ICU 停留时间、念珠菌血症发病前 ICU 入住时间、接受抗生素治疗的患者比例及其发病前抗生素治疗时间以及总死亡率。除了传统的荟萃分析外，还进行了荟萃回归分析，以探讨可能导致异质性的潜在调节因素。
选定研究中患者的平均年龄为 28-76 岁。汇总分析显示，念珠菌血症发病前 ICU 入住时间的平均时间为 12.9 天（95%CI 11.7-14.2）。汇总分析显示，住院时间的平均时间为 36.3±5.3 天（95%CI 25.8-46.7），总死亡率为 49.3%±2.2%（95%CI 45.0%-53.5%）。住院时间（p=0.528）或总死亡率（p=0.111）无显著差异，但 ICU 停留时间（2.8 天，p<0.001）有显著差异。荟萃回归分析发现，与其他地区相比，南美患者在念珠菌血症发病前 ICU 入住时间较长，而亚洲患者的 ICU 入住时间最短。
IC 患者 ICU 入住时间较长，亚洲患者念珠菌血症发病前 ICU 入住时间最短。这表明在 ICU 患者的护理中，应考虑采取更积极的策略来诊断 IC。
