Dipartimento di Scienze Biomediche e Sanità Pubblica Università Politecnica delle Marche, Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I°- Lancisi-Salesi, Ancona, Italy.
Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I°- Lancisi-Salesi, Ancona, Italy.
PLoS One. 2021 May 26;16(5):e0252165. doi: 10.1371/journal.pone.0252165. eCollection 2021.
Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years.
A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Non-ICU patients with candidemia hospitalized during the same time period were considered for comparison purposes. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated.
During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Cumulative incidence was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). There was not a significant difference in species distribution between ICU and non-ICU patients. With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates, were 19% and 41% respectively, the latter being significantly higher than that observed in non-ICU patients. At multivariate analysis, factors associated with increased risk of death were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Mortality did not increased significantly over time.
Neither cumulative incidence nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors in the majority of cases.
念珠菌血症是包括入住重症监护病房（ICU）患者在内的危重病患者的一个严重问题。我们旨在描述意大利一家三级转诊大学医院 ICU 患者血流感染（BSI）的临床和微生物学特征。
对 2010 年 1 月 1 日至 2018 年 12 月 31 日期间，在意大利安科纳一家 980 张床位的大学医院的所有成人患者念珠菌血症病例进行了回顾性观察性研究，该医院设有 5 个 ICU。收集了 ICU 患者念珠菌血症的发病率、人口统计学、临床和微生物学特征、治疗方法和结局。同时还收集了同期住院的非 ICU 患者念珠菌血症的病例进行比较。计算了早期（念珠菌血症发生后 7 天）和晚期（30 天）死亡率。
研究期间，188/505（36%）例念珠菌血症发生在 ICU 患者中。ICU 患者的累积发病率为 9.9/1000 ICU 入院，且随时间保持稳定。白色念珠菌占 52%，其次是近平滑念珠菌（24%）和光滑念珠菌（14%）。ICU 患者和非 ICU 患者的菌种分布无显著差异。除热带念珠菌分离株有 25%显示对氟康唑耐药外，我们的患者对抗真菌药物的耐药性并不令人担忧。早期和晚期死亡率分别为 19%和 41%，后者明显高于非 ICU 患者。多变量分析显示，死亡风险增加的因素有感染性休克、急性肾衰、肺栓塞和缺乏抗真菌治疗。抗真菌治疗的类型并不影响结局。死亡率在时间上没有显著增加。
在我们的机构中，ICU 患者念珠菌血症的累积发病率或死亡率并没有随时间增加。然而，死亡率仍然很高，在大多数情况下与特定的宿主相关因素显著相关。
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