Division of Infectious Diseases, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA.
Clin Infect Dis. 2022 Sep 29;75(6):1031-1036. doi: 10.1093/cid/ciac004.
This study quantifies the mortality attributable to Candida bloodstream infections (BSI) in the modern era of echinocandins.
We conducted a retrospective cohort study of adult patients admitted to Barnes Jewish Hospital, a 1368-bed tertiary care academic hospital, in Saint Louis, Missouri, from 1 February 2012 to 30 April 2019. We identified 626 adult patients with Candida BSI that were frequency-matched with 6269 control patients that had similar Candida BSI risk-factors. The 90-day all-cause mortality attributable to Candida BSI was calculated using three methods-propensity score matching, matching by inverse weighting of propensity score, and stratified analysis by quintile.
The 90-day crude mortality was 42.4% (269 patients) for Candida BSI cases and 17.1% (1083 patients) for frequency-matched controls. Following propensity score-matching, the attributable risk difference for 90-day mortality was 28.4% with hazard ratio (HR) of 2.12 (95% confidence interval [CI], 1.98-2.25, P < .001). In the stratified analysis, the risk for mortality at 90 days was highest in patients in the lowest risk quintile to develop Candida BSI (hazard ratio [HR] 3.13 (95% CI, 2.33-4.19). Patients in this lowest risk quintile accounted for 81(61%) of the 130 untreated patients with Candida BSI. Sixty-nine percent of untreated patients (57/83) died versus 35% of (49/127) of treated patients (P < .001).
Patients with Candida BSI continue to experience high mortality. Mortality attributable to Candida BSI was more pronounced in patients at lowest risk to develop Candida BSI. A higher proportion of these low-risk patients went untreated, experienced higher mortality, and should be the target of aggressive interventions to ensure timely, effective treatment.
本研究量化了在棘白菌素类药物的现代时代，念珠菌血流感染（BSI）导致的死亡率。
我们对密苏里州圣路易斯市 1368 张床位的三级保健学术医院巴恩斯犹太医院的成年住院患者进行了回顾性队列研究。从 2012 年 2 月 1 日至 2019 年 4 月 30 日，我们确定了 626 例成人念珠菌 BSI 患者，并与具有相似念珠菌 BSI 风险因素的 6269 例对照患者进行了频数匹配。使用三种方法（倾向评分匹配、倾向评分逆加权匹配和五分位分层分析）计算念珠菌 BSI 导致的 90 天全因死亡率归因风险差异。
念珠菌 BSI 病例的 90 天粗死亡率为 42.4%（269 例），频数匹配对照的死亡率为 17.1%（1083 例）。经过倾向评分匹配后，90 天死亡率的归因风险差异为 28.4%，风险比（HR）为 2.12（95%置信区间[CI]，1.98-2.25，P<0.001）。在分层分析中，在发展念珠菌 BSI 的风险最低的五分位患者中，90 天死亡的风险最高（HR 3.13（95%CI，2.33-4.19）。在这个最低风险五分位的 130 例未治疗的念珠菌 BSI 患者中，有 81 例（61%）患者未接受治疗。未治疗患者的 69%（57/83）死亡，而治疗患者的 35%（49/127）死亡（P<0.001）。
念珠菌 BSI 患者的死亡率仍然很高。在发生念珠菌 BSI 风险最低的患者中，念珠菌 BSI 导致的死亡率更为明显。这些低风险患者中未接受治疗的比例更高，死亡率更高，应成为积极干预措施的目标，以确保及时、有效的治疗。
