在不同的严重急性呼吸综合征冠状病毒 2 大流行浪潮期间，住院患者念珠菌血症的发病率和死亡率：对 248 家美国医院的多中心评估。

Morbidity and mortality of hospitalised patients with candidemia during the various severe acute respiratory syndrome coronavirus 2 pandemic waves: A multicentre evaluation of 248 US hospitals.

机构信息

Merck & Co., Inc., Rahway, New Jersey, USA.

Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA.

出版信息

Mycoses. 2023 Jun;66(6):483-487. doi: 10.1111/myc.13573. Epub 2023 Feb 9.

DOI:10.1111/myc.13573

PMID:36740751

Abstract

BACKGROUND

Studies evaluating outcomes of COVID-19 patients with candidemia are limited and have only evaluated a single timepoint during the pandemic.

OBJECTIVES

To compare the prevalence and outcomes associated with candidemia in patients based on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) status and through the various pandemic waves (1 March 2020-5 March 2022).

PATIENTS/METHODS: Multicentre, retrospective cohort analysis of data from 248 US medical facilities using the BD Insights Research Database (Becton, Dickinson and Company, Franklin Lakes, New Jersey, USA). Eligible patients were adults aged ≥18 years who were hospitalised for >1 day, had a SARS-CoV-2 test and a positive blood culture for Candida spp.

RESULTS

During the study time frame, there were 2,402,879 hospital admissions; 234,903 (9.7%) and 2,167,976 (90.3%) patients were SARS-CoV-2 positive and negative, respectively. A significantly higher rate of candidemia/1000 admissions was observed in SARS-CoV-2-positive patients compared to SARS-CoV-2-negative patients (3.18 vs. 0.99; p < .001). The highest candidemia rate for SARS-CoV-2-positive patients was observed during the Alpha SARS-CoV-2 wave (June 2020-August 2020) with the lowest candidemia rate during the Omicron wave. Hospital mortality was significantly higher in SARS-CoV-2-positive patients compared to SARS-CoV-2-negative patients with candidemia (59.6% vs. 30.8%; p < .001). When evaluating the mortality rate through the various pandemic waves, the rate for the overall population did not change.

CONCLUSIONS

Our study indicates high morbidity and mortality for hospitalised patients with COVID-19 and candidemia which was consistent throughout the pandemic. Patients with COVID-19 are at an increased risk for candidemia; importantly, the magnitude of which may differ based on the circulating variant.

摘要

背景

评估 COVID-19 合并念珠菌血症患者结局的研究有限，且仅在大流行期间评估了单一时间点的数据。

目的

根据严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）状态和大流行各波次（2020 年 3 月 1 日至 2022 年 3 月 5 日）比较 COVID-19 合并念珠菌血症患者的患病率和结局。

患者/方法：使用 BD Insights Research Database（Becton，Dickinson and Company，Franklin Lakes，New Jersey，USA）进行多中心、回顾性队列分析，纳入 248 家美国医疗机构的数据。合格患者为年龄≥18 岁、住院时间超过 1 天、进行 SARS-CoV-2 检测且血培养阳性的成年患者。

结果

在研究时间段内，共有 2402879 例住院患者；其中 234903 例（9.7%）和 2167976 例（90.3%）患者 SARS-CoV-2 阳性和阴性。与 SARS-CoV-2 阴性患者相比，SARS-CoV-2 阳性患者念珠菌血症/每千例住院患者的发生率显著更高（3.18 比 0.99；p<0.001）。SARS-CoV-2 阳性患者的念珠菌血症发生率最高发生在 Alpha SARS-CoV-2 波（2020 年 6 月至 2020 年 8 月），最低发生率发生在 Omicron 波。与 SARS-CoV-2 阴性念珠菌血症患者相比，SARS-CoV-2 阳性念珠菌血症患者的医院死亡率显著更高（59.6%比 30.8%；p<0.001）。当评估各波次大流行期间的死亡率时，总体人群的死亡率没有变化。