Division of Infectious Diseases, University General Hospital of Patras, Patras, Greece.
Department of Internal Medicine, University General Hospital of Heraklion, Heraklion, Greece.
Infection. 2024 Oct;52(5):1733-1743. doi: 10.1007/s15010-024-02222-z. Epub 2024 Mar 12.
Candidemia is associated with high mortality especially in critically ill patients. Our aim was to identify predictors of mortality among critically ill patients with candidemia with a focus on early interventions that can improve prognosis.
Multicenter retrospective study.
This retrospective study was conducted in Intensive Care Units from three European university hospitals from 2015 to 2021. Adult patients with at least one positive blood culture for Candida spp. were included. Patients who did not require source control were excluded. Primary outcome was 14-day mortality.
A total of 409 episodes of candidemia were included. Most candidemias were catheter related (173; 41%), followed by unknown origin (170; 40%). Septic shock developed in 43% episodes. Overall, 14-day mortality rate was 29%. In Cox proportional hazards regression model, septic shock (P 0.001; HR 2.20, CI 1.38-3.50), SOFA score ≥ 10 points (P 0.008; HR 1.83, CI 1.18-2.86), and prior SARS-CoV-2 infection (P 0.003; HR 1.87, CI 1.23-2.85) were associated with 14-day mortality, while combined early appropriate antifungal treatment and source control (P < 0.001; HR 0.15, CI 0.08-0.28), and early source control without appropriate antifungal treatment (P < 0.001; HR 0.23, CI 0.12-0.47) were associated with better survival compared to those without neither early appropriate antifungal treatment nor source control.
Early source control was associated with better outcome among candidemic critically ill patients.
念珠菌血症与高死亡率相关，尤其是在危重症患者中。我们的目的是确定念珠菌血症危重症患者的死亡预测因素，重点关注可改善预后的早期干预措施。
多中心回顾性研究。
本回顾性研究于 2015 年至 2021 年在三家欧洲大学医院的重症监护病房进行。纳入至少有一次阳性血培养为念珠菌属的成年患者。不进行源头控制的患者被排除在外。主要结局为 14 天死亡率。
共纳入 409 例念珠菌血症发作。大多数念珠菌血症与导管相关（173 例，41%），其次是不明来源（170 例，40%）。43%的病例发生感染性休克。总的来说，14 天死亡率为 29%。在 Cox 比例风险回归模型中，感染性休克（P<0.001；HR 2.20，CI 1.38-3.50）、SOFA 评分≥10 分（P<0.008；HR 1.83，CI 1.18-2.86）和 SARS-CoV-2 感染史（P<0.003；HR 1.87，CI 1.23-2.85）与 14 天死亡率相关，而早期联合适当的抗真菌治疗和源头控制（P<0.001；HR 0.15，CI 0.08-0.28）和早期源头控制而无适当抗真菌治疗（P<0.001；HR 0.23，CI 0.12-0.47）与无早期适当抗真菌治疗或源头控制相比，与更好的生存相关。
早期源头控制与念珠菌血症危重症患者的更好结局相关。
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