长期静脉-静脉体外膜肺氧合患者中念珠菌血症的发生率。

Incidence of candidaemia in prolonged venovenous extracorporeal membrane oxygenation.

机构信息

Department of Microbiology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Infectious Diseases Service, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK.

Infectious Diseases Service, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Mycology Reference Centre Manchester (ECMM Centre of Excellence), Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.

出版信息

J Hosp Infect. 2022 Jan;119:49-53. doi: 10.1016/j.jhin.2021.09.014. Epub 2021 Sep 22.

DOI:10.1016/j.jhin.2021.09.014

PMID:34562545

Abstract

This single-centre retrospective study reports the dynamics of the incidence of candida bloodstream infection (CBSI) in 145 patients receiving venovenous extracorporeal membrane oxygenation (ECMO) for respiratory support between January 2014 and December 2018. The incidence rate and odds ratio (OR) of CBSI were calculated, stratified by week of ECMO exposure. Weekly incidence increased throughout the ECMO run, with an increasing trend in OR (P=0.005), and a window of continued risk after decannulation was observed. Of the 13 patients who developed CBSI, five (38%) received empirical micafungin treatment before positive culture due to clinical suspicion. There is a need for prospective studies aiming to improve ECMO diagnostic stewardship practices and discourage unnecessary antifungal prophylaxis or empiric management.

摘要

本单中心回顾性研究报告了 2014 年 1 月至 2018 年 12 月期间 145 例因呼吸支持而接受静脉-静脉体外膜肺氧合（ECMO）治疗的患者中念珠菌血流感染（CBSI）的发病动态。通过 ECMO 暴露周分层计算 CBSI 的发病率和比值比（OR）。在 ECMO 运行过程中，每周的发病率均增加，OR 呈上升趋势（P=0.005），并且在拔管后仍存在持续风险窗口。在发生 CBSI 的 13 例患者中，由于临床怀疑，有 5 例（38%）在阳性培养前接受了经验性米卡芬净治疗。需要进行前瞻性研究，旨在改进 ECMO 诊断管理实践，避免不必要的抗真菌预防或经验性治疗。