Govender Nelesh P, Todd Jim, Nel Jeremy, Mer Mervyn, Karstaedt Alan, Cohen Cheryl
Emerg Infect Dis. 2021 Jun;27(6):1607-15. doi: 10.3201/eid2706.210128.
We determined the effect of HIV infection on deaths among persons >18 months of age with culture-confirmed candidemia at 29 sentinel hospitals in South Africa during 2012-2017. Of 1,040 case-patients with documented HIV status and in-hospital survival data, 426 (41%) were HIV-seropositive. The in-hospital case-fatality rate was 54% (228/426) for HIV-seropositive participants and 37% (230/614) for HIV-seronegative participants (crude odds ratio [OR] 1.92, 95% CI 1.50-2.47; p<0.001). After adjusting for relevant confounders (n = 907), mortality rates were 1.89 (95% CI 1.38-2.60) times higher among HIV-seropositive participants than HIV-seronegative participants (p<0.001). Compared with HIV-seronegative persons, the stratum-specific adjusted mortality OR was higher among HIV-seropositive persons not managed in intensive care units (OR 2.27, 95% CI 1.47-3.52; p<0.001) than among persons who were (OR 1.56, 95% CI 1.00-2.43; p = 0.05). Outcomes among HIV-seropositive persons with candidemia might be improved with intensive care.
我们确定了2012年至2017年期间，在南非29家定点医院中，HIV感染对年龄大于18个月且血培养确诊为念珠菌血症患者死亡情况的影响。在1040例有HIV状态记录和住院生存数据的病例患者中，426例（41%）HIV血清学检测呈阳性。HIV血清学检测呈阳性参与者的院内病死率为54%（228/426），HIV血清学检测呈阴性参与者的院内病死率为37%（230/614）（粗比值比[OR]为1.92，95%可信区间为1.50 - 2.47；p<0.001）。在对相关混杂因素进行校正后（n = 907），HIV血清学检测呈阳性参与者的死亡率比HIV血清学检测呈阴性参与者高1.89倍（95%可信区间为1.38 - 2.60）（p<0.001）。与HIV血清学检测呈阴性者相比，未在重症监护病房接受治疗的HIV血清学检测呈阳性者的分层校正死亡率OR（OR为2.27，95%可信区间为1.47 - 3.52；p<0.001）高于在重症监护病房接受治疗者（OR为1.56，95%可信区间为1.00 - 2.43；p = 0.05）。对念珠菌血症的HIV血清学检测呈阳性者进行重症监护可能会改善其预后。
