Maurille Charles, Bonhomme Julie, Briant Anaïs R, Parienti Jean-Jacques, Verdon Renaud, Fournier Anna Lucie
Department of Infectious Diseases, CHU de Caen Normandie, UNICAEN, Normandie University, 14000 Caen, France.
INSERM U1311 DynaMicURe, UNICAEN, UNIROUEN, Normandie University, 14000 Caen, France.
J Fungi (Basel). 2022 May 23;8(5):541. doi: 10.3390/jof8050541.
The objective of this study was to evaluate the association between ESCMID adherence and 30-day mortality in candidemia.
We performed a retrospective cohort study in two French tertiary-care hospitals. All patients with at least one positive blood culture (BC) for spp. between January 2013 and December 2019 were included. An adherent case was defined as a candidemia case for which the treatment fulfilled a bundle of defined criteria based on the latest ESCMID recommendations. We explored factors associated with adherence to ESCMID recommendations in an unadjusted model, and we used a propensity score method to address potential channeling biases with regard to 30-day mortality.
During the study period, 165 cases of candidemia were included. Among the ESCMID criteria, funduscopic examination was not performed in 45% and neither was echocardiography in 31%, while the ESCMID criteria were fully implemented in 44 cases (27%). In the propensity score analysis, the all-cause 30-day mortality rate was significantly lower among adherent cases (3.4/36.6, 9%) than among nonadherent cases (42.4/119.5, 36%) (OR = 5.3 95% CI [1.6-17.1]).
In our study, adherence to the bundle of criteria for candidemia management was associated with increased survival, supporting additional efforts to implement these recommendations.
本研究的目的是评估欧洲临床微生物学和传染病学会（ESCMID）指南依从性与念珠菌血症30天死亡率之间的关联。
我们在两家法国三级护理医院进行了一项回顾性队列研究。纳入了2013年1月至2019年12月期间至少有一次血培养（BC）检测到 菌属呈阳性的所有患者。依从性病例定义为根据最新ESCMID建议，其治疗满足一系列既定标准的念珠菌血症病例。我们在未调整模型中探讨了与ESCMID建议依从性相关的因素，并使用倾向评分方法来解决关于30天死亡率的潜在渠道偏差。
在研究期间，纳入了165例念珠菌血症病例。在ESCMID标准方面，45%的病例未进行眼底检查，31%的病例未进行超声心动图检查，而44例（27%）病例完全实施了ESCMID标准。在倾向评分分析中，依从性病例的全因30天死亡率（3.4/36.6，9%）显著低于非依从性病例（42.4/119.5，36%）（OR = 5.3，95%CI [1.6 - 17.1]）。
在我们的研究中，念珠菌血症管理标准的依从性与生存率提高相关，这支持了为实施这些建议而做出的更多努力。
