University of Cologne, Medical Faculty and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), 50937, Cologne, Germany.
University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50937, Cologne, Germany.
Mycoses. 2022 Feb;65(2):211-221. doi: 10.1111/myc.13406. Epub 2021 Dec 8.
The relevance of candidemia has increased over the last decades due to higher incidence rates in an ageing society. Studies on amphotericin B and fluconazole have shown high attributable mortality rates of 38% and 49% in the United States. Incidence rates and locational factors might have an impact on the mortality rates at the University Hospital of Cologne (UHC), Germany.
We performed a matched case-control study including 57 patients with candidemia, hospitalised at the UHC between 1 July 1997 and 30 June 2001. Controls were matched by age, sex, admission date, treatment on intensive care unit (ICU), number of days at risk, underlying diseases, surgical procedures and the Charlson Comorbidity Index.
The incidence of candidemia was 3.5 per 10 000 admissions. For cases and controls, we observed in-hospital-mortality rates of 33.3% and 11.8%, and a 30-day mortality of 23.5% and 7.8% respectively. The attributable mortality rate to candidemia was 21.5%, and at 30 days, it was 15.7%. Underlying conditions were more frequent in cases than in controls, especially central venous catheter (80% vs 33%, P < .001), chronic cardiovascular disease (39.2% vs 25.5%, P = .138), treatment on ICU (31.4% vs 13.7%, P = .033) and chronic liver disease (21.6% vs 0%, P < .001).
The attributable mortality of candidemia at the UHC between 1997 and 2001 was lower compared to studies performed in the United States with a similar design. Contributing factors might be lower incidence rates and less comorbidities in our study.
由于老龄化社会中发病率的上升，过去几十年中念珠菌血症的相关性有所增加。在美国，两性霉素 B 和氟康唑的研究表明，其死亡率分别高达 38%和 49%。发病率和位置因素可能会对德国科隆大学医院（UHC）的死亡率产生影响。
我们进行了一项匹配病例对照研究，纳入了 1997 年 7 月 1 日至 2001 年 6 月 30 日期间在 UHC 住院的 57 例念珠菌血症患者。对照病例通过年龄、性别、入院日期、重症监护病房（ICU）治疗、风险天数、潜在疾病、手术程序和 Charlson 合并症指数进行匹配。
念珠菌血症的发病率为每 10000 例住院患者 3.5 例。对于病例和对照组，我们观察到院内死亡率分别为 33.3%和 11.8%，30 天死亡率分别为 23.5%和 7.8%。念珠菌血症的归因死亡率为 21.5%，30 天时为 15.7%。与对照组相比，病例组的基础疾病更为常见，尤其是中心静脉导管（80%比 33%，P<0.001）、慢性心血管疾病（39.2%比 25.5%，P=0.138）、ICU 治疗（31.4%比 13.7%，P=0.033）和慢性肝脏疾病（21.6%比 0%，P<0.001）。
与采用类似设计的美国研究相比，UHC 在 1997 年至 2001 年期间念珠菌血症的归因死亡率较低。在我们的研究中，可能是由于发病率较低和合并症较少。
