Kobayashi Takaaki, Marra Alexandre R, Schweizer Marin L, Ten Eyck Patrick, Wu Chaorong, Alzunitan Mohammed, Salinas Jorge L, Siegel Marc, Farmakiotis Dimitrios, Auwaerter Paul G, Healy Heather S, Diekema Daniel J
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA.
Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Open Forum Infect Dis. 2020 Aug 3;7(9):ofaa270. doi: 10.1093/ofid/ofaa270. eCollection 2020 Sep.
Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from bacteremia, little is known about the impact of IDC in candidemia.
We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched 5 databases through February 2020 and performed a meta-analysis of the impact of IDC on the mortality of patients with candidemia.
A total of 151 patients met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%; = .002; 23% vs 50%; = .0022, respectively). A systematic literature review returned 216 reports, of which 13 studies including the present report fulfilled the inclusion criteria. Among the 13 studies with a total of 3582 patients, IDC was performed in 50% of patients. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% vs 47.6%), with a pooled relative risk of 0.41 (95% CI, 0.35-0.49). Ophthalmology referral, echocardiogram, and central line removal were performed more frequently among patients receiving IDC.
This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with significantly lower mortality and should be considered in all patients with candidemia.
念珠菌血症的发病率和死亡率仍然高得令人无法接受。虽然已知感染病会诊（IDC）可降低菌血症的死亡率，但对于IDC在念珠菌血症中的影响知之甚少。
我们对一家大型三级护理医院2015年至2019年期间的念珠菌血症患者进行了一项回顾性观察队列研究。比较了接受IDC和未接受IDC患者的粗死亡率。然后，我们系统检索了截至2020年2月的5个数据库，并对IDC对念珠菌血症患者死亡率的影响进行了荟萃分析。
共有151例患者符合纳入标准，其中129例（85%）接受了IDC。IDC组的30天和90天死亡率显著较低（分别为18%对50%；P = 0.002；23%对50%；P = 0.0022）。系统文献综述检索到216篇报告，其中包括本报告在内的13项研究符合纳入标准。在这13项共纳入3582例患者的研究中，50%的患者接受了IDC。总体死亡率为38.2%，有利于IDC组的差异有统计学意义（28.4%对47.6%），合并相对风险为0.41（95%CI，0.35 - 0.49）。接受IDC的患者中，眼科转诊、超声心动图检查和拔除中心静脉导管的操作更为频繁。
本研究是第一项评估IDC与念珠菌血症死亡率之间关联的系统文献综述和荟萃分析。IDC与显著降低的死亡率相关，所有念珠菌血症患者均应考虑进行IDC。
