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泰国最大的国立三级转诊医院诗里拉吉医院念珠菌血症患者非血流感染的危险因素及结局

Risk Factors and Outcomes of Non- Bloodstream Infection in Patients with Candidemia at Siriraj Hospital-Thailand's Largest National Tertiary Referral Hospital.

作者信息

Ngamchokwathana Chaiyapong, Chongtrakool Piriyaporn, Waesamaae Amiroh, Chayakulkeeree Methee

机构信息

Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

出版信息

J Fungi (Basel). 2021 Apr 1;7(4):269. doi: 10.3390/jof7040269.

Abstract

This study aimed to investigate the risk factors for and the outcomes of patients with candidemia caused by non-. Candidemia patients treated at Siriraj Hospital (Bangkok, Thailand) during January 2016 to December 2017 were enrolled. A total of 156 patients (mean age: 65 years, 56.4% male) were included. The most prevalent underlying conditions were diabetes (32.1%), chronic cardiac disease (28.2%), chronic kidney disease (26.9%), and hematologic malignancies (21.2%). species isolated from patient blood were (49.4%), (28.8%), (16.7%), and (5.1%). Fluconazole resistance was significantly increased in (37.8%). No independent risk factors were associated with patients with non- candidemia compared to those with candidemia. There was no significant difference in mortality between patients with non- candidemia and patients with candidemia (OR: 1.35, 95% CI: 0.64-2.85). When compared with candidemia, multivariate analysis revealed chronic liver disease (OR: 11.39, 95% CI: 1.38-94.02), neutropenia (OR: 4.31, 95% CI: 1.34-13.87), and male gender (OR: 2.34, 95% CI: 1.04-5.29) to be independent risk factors for candidemia. The observed high resistance of to fluconazole indicates that fluconazole should not be used for empirical antifungal treatment in these patients.

摘要

本研究旨在调查非[具体念珠菌种类未提及]念珠菌血症患者的危险因素及预后情况。纳入了2016年1月至2017年12月期间在泰国曼谷诗里拉吉医院接受治疗的念珠菌血症患者。共纳入156例患者(平均年龄:65岁,男性占56.4%)。最常见的基础疾病为糖尿病(32.1%)、慢性心脏病(28.2%)、慢性肾脏病(26.9%)和血液系统恶性肿瘤(21.2%)。从患者血液中分离出的菌种为[具体菌种1](49.4%)、[具体菌种2](28.8%)、[具体菌种3](16.7%)和[具体菌种4](5.1%)。[具体菌种1]对氟康唑的耐药性显著增加(达37.8%)。与[具体念珠菌种类未提及]念珠菌血症患者相比,非[具体念珠菌种类未提及]念珠菌血症患者无独立危险因素。非[具体念珠菌种类未提及]念珠菌血症患者与[具体念珠菌种类未提及]念珠菌血症患者的死亡率无显著差异(比值比:1.35,95%置信区间:0.64 - 2.85)。与[具体念珠菌种类未提及]念珠菌血症相比,多因素分析显示慢性肝病(比值比:11.39,95%置信区间:1.38 - 94.02)、中性粒细胞减少(比值比:4.31,95%置信区间:1.34 - 13.87)和男性(比值比:2.34,95%置信区间:1.04 - 5.29)是[具体念珠菌种类未提及]念珠菌血症的独立危险因素。观察到[具体念珠菌种类未提及]对氟康唑的高耐药性表明,在这些患者中不应将氟康唑用于经验性抗真菌治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ced2/8066724/952bd823834f/jof-07-00269-g001.jpg

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