Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.
Medical University of Varna, Varna, Bulgaria.
Mycoses. 2020 Dec;63(12):1373-1381. doi: 10.1111/myc.13177. Epub 2020 Sep 27.
Candidemia is among the most frequent nosocomial bloodstream infections. Landmark case-control studies on amphotericin B and fluconazole estimated attributable mortality rates of 38% and 49%, respectively. After introduction of echinocandins, these may have decreased.
In a case-control design, 100 consecutive, hospitalised patients with candidemia were enrolled at the University Hospital of Cologne, Germany between 2014 and 2017. Controls were patients without candidemia matched for age, sex, year and duration of hospitalisation, main admission diagnosis and Patient Clinical Complexity Level (PCCL). Main data captured were risk factors for candidemia, attributable mortality rates and diagnostic and therapeutic adherence according to the EQUAL Candida score.
Overall mortality rates for cases and controls were 43% and 17% (P < .001), respectively; day 30 mortality rates were 38% and 11% (P = .03), accounting for an attributable mortality of 26% and 27%. Guideline adherence was higher in surviving vs non-surviving patients: while survivors reached a median of 17 (IQR: 16-19) points, non-surviving cases reached a median 16 (IQR: 14-18) points out of 22 maximum achievable points (P = .028). Risk factors for candidemia were more frequent in cases compared to control patients, especially chronic pulmonary disease (25% vs 16%; P = n.s.), chronic liver disease (21% vs 6%; P = .002), stay on intensive care unit (70% vs 64%; P = n.s.), respiratory failure (56% vs 50%; P = n.s.) and central venous catheter (97% vs 35%; P < .001).
Attributable mortality of nosocomial candidemia is still substantial but has decreased compared to previous studies with similar design.
念珠菌血症是最常见的医院获得性血流感染之一。关于两性霉素 B 和氟康唑的标志性病例对照研究分别估计其归因死亡率为 38%和 49%。在棘白菌素类药物问世后，这些死亡率可能有所下降。
采用病例对照设计，在德国科隆大学医院，于 2014 年至 2017 年期间连续纳入 100 例住院念珠菌血症患者。对照组为年龄、性别、住院年份和时间、主要入院诊断和患者临床复杂性水平（PCCL）相匹配、无念珠菌血症的患者。主要收集的数据包括念珠菌血症的危险因素、归因死亡率以及根据 EQUAL Candida 评分的诊断和治疗依从性。
病例组和对照组的总死亡率分别为 43%和 17%（P<0.001），第 30 天死亡率分别为 38%和 11%（P=0.03），归因死亡率分别为 26%和 27%。与非幸存者相比，幸存者的指南依从性更高：幸存者达到中位数 17 分（IQR：16-19），而非幸存者达到中位数 16 分（IQR：14-18）（22 分中最多可得分数，P=0.028）。与对照组相比，病例组的念珠菌血症危险因素更为常见，尤其是慢性肺部疾病（25%比 16%；P=n.s.）、慢性肝病（21%比 6%；P=0.002）、入住重症监护病房（70%比 64%；P=n.s.）、呼吸衰竭（56%比 50%；P=n.s.）和中央静脉导管（97%比 35%；P<0.001）。
医院获得性念珠菌血症的归因死亡率仍然很高，但与具有类似设计的先前研究相比已有所下降。
