评估肠外营养治疗期间使用的抗生素对念珠菌血症的影响。

Evaluation of the effect of antibiotics used during parenteral nutrition treatment on Candidemia.

机构信息

Hacettepe University, Faculty of Pharmacy, Department of Clinical Pharmacy - Ankara, Turkey.

Çukurova University, Faculty of Pharmacy, Department of Clinical Pharmacy - Adana, Turkey.

出版信息

Rev Assoc Med Bras (1992). 2021 Oct;67(10):1448-1453. doi: 10.1590/1806-9282.20210650.

DOI:10.1590/1806-9282.20210650

PMID:35018974

Abstract

OBJECTIVE

Parenteral nutrition is an important risk factor for candidemia. In this risk analysis study, the effect of previous antibiotic administration apart from the length of hospital stay, duration of Parenteral nutrition treatment, and Candida score parameters on developing candidemia was evaluated in the non-neutropenic patients receiving Parenteral nutrition treatment.

METHODS

In this double center, retrospective, and cross-sectional study, the data of patients who received Parenteral nutrition treatment were collected. Patients with or without candidemia after the initiation of Parenteral nutrition treatment were compared in terms of demographic features, Candida score, length of hospital stay, duration of Parenteral nutrition treatment, and previous use of antibiotics. Then, predictor factors affecting the probability of candidemia during Candida growth time were determined by the Cox regression analysis.

RESULTS

A total of 148 patients (59.5% males) were included and 16 (10.81%) of these had candidemia after initiation of parenteral nutrition treatment. The median (min-max) duration of parenteral nutrition treatment was 11 (4-72) days and the Candida growth time was 13 (7-29) days. Statistically significant differences were found between patients with or without candidemia groups in terms of length of hospital stay (p<0.001), duration of parenteral nutrition treatment (p<0.001), and Candida score (p<0.001). To determine the effect of these variables and antibiotics on candidemia, length of hospital stay [Hazard Ratio 1.030; p=0.021] and piperacillin-tazobactam (Hazard Ratio 5.626; p=0.030) were found significant and independent risk factors on the development of candidemia.

CONCLUSION

There are some well-known risk factors including length of hospital stay, duration of Parenteral nutrition treatment, and Candida score; the potential impact of piperacillin-tazobactam administration should also be considered since they may be effective on the development of candidemia.

摘要

目的

肠外营养是导致念珠菌血症的一个重要危险因素。在这项风险分析研究中，评估了除住院时间、肠外营养治疗时间、念珠菌评分参数外，先前使用抗生素对接受肠外营养治疗的非中性粒细胞减少患者发生念珠菌血症的影响。

方法

在这项双中心、回顾性、横断面研究中，收集了接受肠外营养治疗患者的数据。比较了肠外营养治疗开始后发生念珠菌血症和未发生念珠菌血症的患者的人口统计学特征、念珠菌评分、住院时间、肠外营养治疗时间以及先前使用抗生素的情况。然后，通过 Cox 回归分析确定影响念珠菌生长时间内念珠菌血症发生概率的预测因素。

结果

共纳入 148 例患者（男性 59.5%），其中 16 例（10.81%）在开始肠外营养治疗后发生念珠菌血症。肠外营养治疗的中位（最小-最大）时间为 11（4-72）天，念珠菌生长时间为 13（7-29）天。在住院时间（p<0.001）、肠外营养治疗时间（p<0.001）和念珠菌评分（p<0.001）方面，有念珠菌血症组与无念珠菌血症组患者之间存在显著差异。为了确定这些变量和抗生素对念珠菌血症的影响，住院时间（风险比 1.030；p=0.021）和哌拉西林他唑巴坦（风险比 5.626；p=0.030）被发现是发展为念珠菌血症的显著且独立的危险因素。