Hou Jie, Deng Jin, Liu Ya, Zhang Weili, Wu Siying, Liao Quanfeng, Ma Ying, Kang Mei
Division of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China.
Antibiotics (Basel). 2022 Jun 9;11(6):788. doi: 10.3390/antibiotics11060788.
The aim of this study was to investigate the current status of candidemia and evaluate the clinical characteristics, risk factors and outcomes among different species. We conducted a retrospective study by univariate and multivariate analysis between and (NAC) species in a Chinese national medical center from 2016 to 2020. Among the 259 episodes, (38.6%) was the leading species, followed by (24.3%), (20.5%), and (12.4%). Most and were susceptible to nine tested antifungal agents, whereas showed 30.2~65.9% resistance/non-wild-type to four azoles with great cross-resistance, indicating that fluconazole should not be used for empirical antifungal treatment. In multivariable models, the factor related to an increased risk of NAC was glucocorticoid exposure, whereas gastrointestinal hemorrhage and thoracoabdominal drainage catheters were associated with an increased risk in . Subgroup analysis revealed leukemia and lymphoma, as well as glucocorticoid exposure, to be factors independently associated with in comparison with candidemia. No significant differences in 7-day mortality or 30-day mortality were observed between and NAC. This study may provide useful information with respect to choosing empirical antifungal agents and exploring differences in molecular mechanisms.
本研究旨在调查念珠菌血症的现状，并评估不同菌种之间的临床特征、危险因素及预后情况。我们于2016年至2020年在中国一家国家级医疗中心，通过单因素和多因素分析对念珠菌血症（NAC）菌种进行了一项回顾性研究。在259例病例中，白色念珠菌（38.6%）是主要菌种，其次是热带念珠菌（24.3%）、光滑念珠菌（20.5%）和近平滑念珠菌（12.4%）。大多数白色念珠菌和热带念珠菌对九种测试抗真菌药物敏感，而光滑念珠菌对四种唑类药物显示出30.2%至65.9%的耐药性/非野生型，且具有高度交叉耐药性，这表明氟康唑不应作为经验性抗真菌治疗药物。在多变量模型中，与非白色念珠菌血症风险增加相关的因素是糖皮质激素暴露，而胃肠道出血和胸腹引流管与光滑念珠菌血症风险增加有关。亚组分析显示，与白色念珠菌血症相比，白血病和淋巴瘤以及糖皮质激素暴露是与非白色念珠菌血症独立相关的因素。白色念珠菌血症和非白色念珠菌血症在7天死亡率或30天死亡率方面未观察到显著差异。本研究可能为选择经验性抗真菌药物以及探索分子机制差异提供有用信息。
