2006年至2017年重症监护病房念珠菌血症的流行病学趋势：韩国国家医疗保健相关感染监测系统的结果
Trends in the Epidemiology of Candidemia in Intensive Care Units From 2006 to 2017: Results From the Korean National Healthcare-Associated Infections Surveillance System.
作者信息
Kim Eun Jin, Lee Eunyoung, Kwak Yee Gyung, Yoo Hyeon Mi, Choi Ji Youn, Kim Sung Ran, Shin Myoung Jin, Yoo So-Yeon, Cho Nan-Hyoung, Choi Young Hwa
机构信息
Department of Infectious Diseases, Ajou University School of Medicine, Suwon, South Korea.
Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.
出版信息
Front Med (Lausanne). 2020 Dec 17;7:606976. doi: 10.3389/fmed.2020.606976. eCollection 2020.
Candidemia is an important healthcare-associated infection (HAI) in intensive care units (ICUs). However, limited research has been conducted on candidemia in the Republic of Korea. We aimed to analyze the secular trends in the incidence and distribution of candidemia in ICUs over 12-years using data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS). KONIS was established in 2006 and has performed prospective surveillance of HAIs including bloodstream infections (BSIs) in ICUs. We evaluated the trends in the distribution of causative pathogens and the incidence of candidemia. From 2006 to 2017, 2,248 candidemia cases occurred in 9,184,264 patient-days (PDs). The pooled mean incidence rates of candidemia significantly decreased from 3.05 cases/10,000 PDs in 2006 to 2.5 cases/10,000 PDs in 2017 ( = 0.001). Nevertheless, the proportion of candidemia gradually increased from 15.2% in 2006 to 16.6% in 2017 ( = 0.001). The most frequent causative pathogen of BSIs from 2006 to 2012 was ; however, spp. emerged as the most frequent causative pathogen since 2013. (39.9%) was the most common among spp. causing BSIs, followed by (20.2%) and (18.2%). The proportion of candidemia caused by significantly increased from 8.9% in 2006 to 17.9% in 2017 ( < 0.001). There was no significant change in the distribution of spp. by year ( = 0.285). The most common source of BSIs was central lines associated BSI (92.5%). There was a significant increase in the proportion of candidemia by year in hospitals with organ transplant wards (from 18.9% in 2006 to 21.1% in 2017, = 0.003), hospitals with <500 beds (from 2.7% in 2006 to 13.6% in 2017, < 0.001), and surgical ICUs (from 16.2% in 2006 to 21.7% in 2017, = 0.003). The proportion of candidemia has increased in Korea, especially in hospitals with <500 beds and surgical ICUs. Thus, appropriate infection control programs are needed.
念珠菌血症是重症监护病房（ICU）中一种重要的医疗相关感染（HAI）。然而，韩国针对念珠菌血症的研究有限。我们旨在利用韩国国家医疗相关感染监测系统（KONIS）的数据，分析12年间ICU中念珠菌血症的发病率和分布的长期趋势。KONIS于2006年建立，对包括ICU血流感染（BSI）在内的HAI进行前瞻性监测。我们评估了致病病原体的分布趋势和念珠菌血症的发病率。2006年至2017年期间，在9184264个患者日（PDs）中发生了2248例念珠菌血症病例。念珠菌血症的合并平均发病率从2006年的3.05例/10000个PDs显著下降至2017年的2.5例/10000个PDs（P = 0.001）。然而，念珠菌血症的比例从2006年的15.2%逐渐增加至2017年的16.6%（P = 0.001）。2006年至2012年期间，BSI最常见的致病病原体是[未提及具体病原体名称]；然而，自2013年以来，[未提及具体病原体名称]属菌种成为最常见的致病病原体。在引起BSI的[未提及具体病原体名称]属菌种中，[未提及具体病原体名称]（39.9%）最为常见，其次是[未提及具体病原体名称]（20.2%）和[未提及具体病原体名称]（18.2%）。由[未提及具体病原体名称]引起的念珠菌血症比例从2006年的8.9%显著增加至2017年的17.9%（P < 0.001）。[未提及具体病原体名称]属菌种的分布随年份无显著变化（P = 0.285）。BSI最常见的来源是中心静脉导管相关BSI（92.5%）。在设有器官移植病房的医院（从2006年的18.9%增至2017年的21.1%，P = 0.003）、床位<500张的医院（从2006年的2.7%增至2017年的13.6%，P < 0.001）以及外科ICU（从2006年的16.2%增至2017年的21.7%，P = 0.003）中，念珠菌血症的比例随年份显著增加。韩国念珠菌血症的比例有所上升，尤其是在床位<500张的医院和外科ICU。因此，需要适当的感染控制方案。
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