高龄患者医院内念珠菌血症的临床特征和死亡率：一项意大利多中心研究。
Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study.
机构信息
Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy,
Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy.
出版信息
Gerontology. 2020;66(6):532-541. doi: 10.1159/000510638. Epub 2020 Oct 16.
INTRODUCTION
Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years.
OBJECTIVE
The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18-74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups.
METHODS
We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy.
RESULTS
A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, p < 0.002 and p < 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, p < 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00-1.09, p = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12-155.20, p = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42-223.10, p < 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03-0.33, p < 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17-10.47, p = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02-6.53, p = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16-1.00, p = 0.050).
CONCLUSION
Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.
引言
老年人是念珠菌血症的一个已知危险因素，但很少有数据可用于评估非常高龄（≥75 岁）患者中念珠菌血症的预后影响。
目的
本研究旨在评估两组念珠菌血症患者（≥75 岁的高龄患者和 18-74 岁的成人和老年患者）的医院获得性念珠菌血症的危险因素。此外，还分别分析了两组患者的死亡（30 天死亡率）的危险因素。
方法
我们纳入了 2011 年 1 月至 2013 年 12 月在意大利东北部 6 家转诊医院发生的所有连续的医院获得性念珠菌血症病例。
结果
共发生 683 例医院获得性念珠菌血症病例。其中，293 例（42.9%）发生在高龄患者中，390 例（57.1%）发生在成人和老年患者中。与成人和老年患者相比，高龄患者更常出现住院于内科病房、慢性肾功能衰竭、留置导尿管和外周肠外营养（PPN）。在前者中，与成人和老年患者相比，适当的抗真菌治疗（73.2%）和中心静脉导管（CVC）拔除（67.6%）的发生率较低（分别为 82.5%和 80%，p < 0.002 和 p < 0.004）。高龄患者的 30 天死亡率高于成人和老年患者（47.8%比 23.6%，p < 0.0001）。在成人和老年患者中，死亡的独立危险因素为年龄（OR 1.04，95%CI 1.00-1.09，p = 0.038）、近期化疗史（OR 22.01，95%CI 3.12-155.20，p = 0.002）和严重脓毒症（OR 40.68，95%CI 7.42-223.10，p < 0.001）；CVC 拔除与更高的生存概率相关（OR 0.10，95%CI 0.03-0.33，p < 0.001）。在高龄患者中，死亡的独立危险因素为 PPN（OR 3.5，95%CI 1.17-10.47，p = 0.025）和住院于内科病房（OR 2.58，95%CI 1.02-6.53，p = 0.046），而 CVC 拔除与生存改善相关（OR 0.40，95%CI 0.16-1.00，p = 0.050）。
结论
高龄患者的 30 天死亡率较高，与念珠菌血症管理不当有关，尤其是在内科病房。
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