Ye Naifang, Liu Zhou, Tang Wei, Li Xin, Chu Wenwen, Zhou Qiang
Department of Clinical Laboratory Medicine, The Second Hospital of Anhui Medical University, Anhui Medical University, Hefei, People's Republic of China.
Infect Drug Resist. 2022 Aug 26;15:4887-4898. doi: 10.2147/IDR.S378629. eCollection 2022.
bloodstream infection (BSI), the fourth most common nosocomial BSI, is an urgent global health challenge with the tremendous growth in antifungal resistance rate and mortality rate.
To establish the epidemiology, species distribution, risk factors, and 30-day mortality of candidaemia among 115 patients in this 6-year surveillance study.
We retrospectively analyzed the clinical characteristics, epidemiology, antifungal susceptibility patterns, and risk factors for morbidity and mortality of 115 candidaemia cases diagnosed in one tertiary care hospital from January 2016 through December 2021.
Of the 115 candidaemia cases, the most prevalent species were (33.0%), followed by (27.8%), complex (19.1%), and others. The overall incidence was 0.21 cases/1000 admissions. The overall crude resistance rate of spp. against azoles was 20.0% (23/115), while showed a significant increase in the resistance rate to azoles (from 1/6, 16.7% in 2017 to 6/10, 60.0% in 2021). Multivariate analyses demonstrated that hematological malignancy and neutropenia were significantly associated with BSI than non- BSI. BSI had a significantly higher rate of previous surgery than non- BSI. BSI had a significantly higher rate of receiving total parenteral nutrition (TPN). The overall 30-day mortality rate was 27.0% (31/115). The presence of high age-adjusted Charlson comorbidity index (aCCI), neutropenia, and septic shock were factors independently associated with increased 30-day mortality.
are emerging as the predominant isolate in candidaemia. Of note, the unexpectedly increased resistance rate to azoles in BSI was observed. The aCCI scores, neutropenia, and septic shock were independently associated with 30-day mortality. Prompt, adequate antifungal treatment among high-risk patients may lead to a reduction in mortality.
血流感染（BSI）是第四常见的医院获得性感染，随着抗真菌耐药率和死亡率的急剧上升，它已成为一项紧迫的全球卫生挑战。
在这项为期6年的监测研究中，确定115例念珠菌血症患者的流行病学、菌种分布、危险因素及30天死亡率。
我们回顾性分析了2016年1月至2021年12月在一家三级护理医院确诊的115例念珠菌血症病例的临床特征、流行病学、抗真菌药敏模式以及发病和死亡的危险因素。
在115例念珠菌血症病例中，最常见的菌种是[具体菌种1]（33.0%），其次是[具体菌种2]（27.8%）、[具体菌种3]复合体（19.1%）等。总体发病率为0.21例/1000次入院。念珠菌属对唑类药物的总体粗耐药率为20.0%（23/115），而[具体菌种4]对唑类药物的耐药率显著上升（从2017年的1/6，16.7%升至2021年的6/10，60.0%）。多因素分析表明，血液系统恶性肿瘤和中性粒细胞减少与念珠菌血症性BSI的相关性显著高于非念珠菌血症性BSI。念珠菌血症性BSI既往手术率显著高于非念珠菌血症性BSI。念珠菌血症性BSI接受全胃肠外营养（TPN）的比例显著更高。总体30天死亡率为27.0%（31/115）。高龄校正Charlson合并症指数（aCCI）、中性粒细胞减少和感染性休克是与30天死亡率增加独立相关的因素。
[具体菌种]正在成为念珠菌血症中的主要分离菌。值得注意的是，观察到念珠菌血症性BSI中对唑类药物的耐药率意外上升。aCCI评分、中性粒细胞减少和感染性休克与30天死亡率独立相关。对高危患者及时进行充分的抗真菌治疗可能会降低死亡率。
