Brescini Lucia, Mazzanti Sara, Morroni Gianluca, Pallotta Francesco, Masucci Annamaria, Orsetti Elena, Montalti Roberto, Barchiesi Francesco
Dipartimento di Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy.
Clinica Malattie Infettive Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I°-Lancisi-Salesi, Ancona, Italy.
Mycopathologia. 2022 Jun;187(2-3):181-188. doi: 10.1007/s11046-022-00624-x. Epub 2022 Mar 17.
Candidemia is an alarming problem in critically ill patients including those admitted in Internal Medicine Wards (IMWs). Here, we analyzed all cases of candidemia in adult patients hospitalized over nine years (2010-2018) in IMWs of a 980-bedded University Hospital of Ancona, Italy. During the study period, 218/505 (43%) episodes of candidemia occurred in IMWs patients. The cumulative incidence was 2.5/1000 hospital admission and increased significantly over time (p = 0.013). Patients were predominantly male, with a median age of 68 years. Cardiovascular diseases and solid tumors were the most frequent comorbidities. Candida albicans accounted for 51% of the cases, followed by C. parapsilosis (25%), C. tropicalis (9%) and C. glabrata (7%). Thirty-day mortality was 28% and did not increased significantly over time. By multivariate logistic regression analysis, the presence of neutropenia (OR 7.247 [CI95% 1,368-38,400; p = 0.020]), pneumonia (OR 2.323 [CI95% 1,105-4,884; p = 0.026]), and being infected with C. albicans (OR 2.642 [95% CI 1,223-5,708; p = 0.013) emerged as independent predictors of mortality. The type of antifungal therapy did not influence the outcome. Overall, these data indicate that patients admitted to IMWs are increasingly at higher risk of developing candidemia. Mortality rate remains high and significantly associated with both microbiologic- and host-related factors.
念珠菌血症在重症患者中是一个令人担忧的问题，包括那些入住内科病房（IMWs）的患者。在此，我们分析了意大利安科纳一家拥有980张床位的大学医院内科病房在九年（2010 - 2018年）期间收治的成年患者中所有念珠菌血症病例。在研究期间，内科病房患者发生了218/505（43%）例念珠菌血症。累积发病率为每1000例住院患者中有2.5例，且随时间显著增加（p = 0.013）。患者以男性为主，中位年龄为68岁。心血管疾病和实体瘤是最常见的合并症。白色念珠菌占病例的51%，其次是近平滑念珠菌（25%）、热带念珠菌（9%）和光滑念珠菌（7%）。30天死亡率为28%，且未随时间显著增加。通过多因素逻辑回归分析，中性粒细胞减少（比值比7.247 [95%置信区间1.368 - 38400；p = 0.020]）、肺炎（比值比2.323 [95%置信区间1.105 - 4.884；p = 0.026]）以及感染白色念珠菌（比值比2.642 [95%置信区间1.223 - 5.708；p = 0.013]）是死亡率的独立预测因素。抗真菌治疗的类型不影响治疗结果。总体而言，这些数据表明入住内科病房的患者发生念珠菌血症的风险越来越高。死亡率仍然很高，且与微生物学和宿主相关因素均显著相关。
