Kwon Yong Jun, Won Eun Jeong, Jeong Seok Hoon, Shin Kyeong Seob, Shin Jeong Hwan, Kim Young Ree, Kim Hyun Soo, Kim Young Ah, Uh Young, Kim Taek Soo, Park Jae Hyeon, Lee Jaehyeon, Choi Min Ji, Byun Seung A, Kim Soo Hyun, Shin Jong Hee
Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju 61469, Korea.
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea.
J Fungi (Basel). 2021 Jul 24;7(8):597. doi: 10.3390/jof7080597.
We investigated mortality and predictors of mortality due to intensive care unit-associated candidemia (ICUAC) versus non-ICUAC by species. This study included all candidemia cases in 11 hospitals from 2017 to 2018 in South Korea. The all-cause mortality rates in all 370 patients with ICUAC were approximately twofold higher than those in all 437 patients with non-ICUAC at 7 days (2.3-fold, 31.1%/13.3%), 30 days (1.9-fold, 49.5%/25.4%), and 90 days (1.9-fold, 57.8%/30.9%). Significant species-specific associations with 7- and 30-day ICUAC-associated mortality were not observed. Multivariate analysis revealed that ICU admission was an independent predictor of (OR, 2.07-2.48) and -associated mortality (OR, 6.06-11.54). Fluconazole resistance was a predictor of -associated mortality (OR, 2.80-5.14). Lack (less than 3 days) of antifungal therapy was the strongest predictor of 7-day mortality due to ICUAC caused by (OR, 18.33), (OR, 10.52), and (OR, 21.30) compared with 30- and 90-day mortality (OR, 2.72-6.90). ICUAC had a stronger association with lack of antifungal therapy (55.2%) than ICUAC caused by other species (30.6-36.7%, all < 0.05). Most predictors of mortality associated with ICUAC were distinct from those associated with non-ICUAC and were mediated by species.
我们按菌种调查了重症监护病房相关性念珠菌血症（ICUAC）与非ICUAC所致死亡率及死亡预测因素。本研究纳入了2017年至2018年韩国11家医院的所有念珠菌血症病例。370例ICUAC患者的全因死亡率在7天（2.3倍，31.1%/13.3%）、30天（1.9倍，49.5%/25.4%）和90天（1.9倍，57.8%/30.9%）时比437例非ICUAC患者约高两倍。未观察到与7天和30天ICUAC相关死亡率有显著菌种特异性关联。多变量分析显示，入住ICU是（比值比，2.07 - 2.48）和相关死亡率（比值比，6.06 - 11.54）的独立预测因素。氟康唑耐药是相关死亡率的预测因素（比值比，2.80 - 5.14）。与30天和90天死亡率（比值比，2.72 - 6.90）相比，抗真菌治疗缺乏（少于3天）是由（比值比，18.33）、（比值比，10.52）和（比值比，21.30）引起的ICUAC所致7天死亡率的最强预测因素。与其他菌种引起的ICUAC（30.6% - 36.7%，均P < 0.05）相比，ICUAC与抗真菌治疗缺乏的关联更强（55.2%）。与ICUAC相关的大多数死亡预测因素与非ICUAC相关的不同，且由菌种介导。
