Araujo Jordana Machado, de Almeida Junior João Nóbrega, Magri Marcello Mihailenko Chaves, Costa Silvia Figueiredo, Guimarães Thaís
Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil.
Central Laboratory Division, Hospital das Clínicas, University of São Paulo, São Paulo 05403-900, Brazil.
J Fungi (Basel). 2024 Apr 3;10(4):268. doi: 10.3390/jof10040268.
Candidemia is one of the healthcare-associated infections that has high mortality. The risk factors that predispose a patient to develop this infection are mostly found in patients of greater severity and COVID-19 contributes to the risk of death. The aim of this study is to evaluate epidemiological characteristics and risk factors for mortality in patients with candidemia before and during the COVID-19 pandemic era. This is a retrospective study conducted at Instituto Central from 2016 to 2020 of patients with candidemia that were evaluated for demographic data, medical history, risk factors, microbiological data, therapeutic measures, complementary exams, device management, and outcome defined by 30-day mortality. A total of 170 episodes were included (58.2% males; mean age of 56 years). The overall incidence density of candidemia per 1000 admissions and per 1000 patient-days was 1.17 and 0.17, respectively, with an increase of 38% in the year 2020. The use of a central venous catheter was the most prevalent (93.5%) condition, followed by the previous use of antibiotics (91.1%). Corticosteroid use ranked seventh (56.4%). was responsible for 71 (41.7%) of the isolates, followed by and , with 34 (20%) isolates each. Echinocandin was prescribed in 60.1% of cases and fluconazole in 37%. Echocardiography resulted in six (5.08%) cases of endocarditis and fundoscopy resulting in two (2.4%) endophthalmitis. The 30-day mortality was 93/170 (54.7%). The risk factors associated with mortality were age (OR 1.03, CI 95% 1.01-1.06), heart disease (OR 7.51, CI 95% 1.48-37.9), hemodialysis (OR 3.68, CI 95% 1.28-10.57), and use of corticosteroids (OR 2.83, CI 95% 1.01-7.92). The COVID-19 pandemic had an impact on the increase incidence of candidemia. The persistently high mortality highlights the need for better management strategies, control of risk factors, and guarantee of adequate treatment.
念珠菌血症是一种死亡率很高的医疗相关感染。使患者易患这种感染的危险因素大多见于病情较重的患者，而新型冠状病毒肺炎（COVID-19）会增加死亡风险。本研究的目的是评估COVID-19大流行时代之前和期间念珠菌血症患者的流行病学特征和死亡危险因素。这是一项在中央研究所于2016年至2020年对念珠菌血症患者进行的回顾性研究，评估了人口统计学数据、病史、危险因素、微生物学数据、治疗措施、辅助检查、设备管理以及以30天死亡率定义的结局。共纳入170例病例（男性占58.2%；平均年龄56岁）。念珠菌血症每1000次入院和每1000患者日的总体发病密度分别为1.17和0.17，2020年增加了38%。使用中心静脉导管是最常见的情况（93.5%），其次是先前使用抗生素（91.1%）。使用皮质类固醇排在第七位（56.4%）。白色念珠菌占分离株的71株（41.7%），其次是热带念珠菌和光滑念珠菌，各有34株（20%）分离株。60.1%的病例使用了棘白菌素，37%的病例使用了氟康唑。超声心动图检查发现6例（5.08%）心内膜炎，眼底镜检查发现2例（2.4%）眼内炎。30天死亡率为93/170（54.7%）。与死亡率相关的危险因素包括年龄（比值比1.03，95%置信区间1.01 - 1.06）、心脏病（比值比7.51，95%置信区间1.48 - 37.9）、血液透析（比值比3.68，95%置信区间1.28 - 10.57）以及使用皮质类固醇（比值比2.83，95%置信区间1.01 - 7.92）。COVID-19大流行对念珠菌血症发病率的增加有影响。持续的高死亡率凸显了需要更好的管理策略、控制危险因素以及保证充分治疗。
