University of Miami Health System, Miami, Florida, USA.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
Clin Infect Dis. 2024 Nov 22;79(5):1262-1268. doi: 10.1093/cid/ciae411.
Candida auris has become a growing concern worldwide because of increases in incidence of colonization and reports of invasive infections. There are limited data on clinical factors associated with poor outcomes in patients with C. auris bloodstream infection (BSI).
We assembled a multicenter retrospective cohort of patients with C. auris BSI from 2 geographics areas in US healthcare settings. We collected data on demographic, clinical, and microbiologic characteristics to describe the cohort and constructed multivariate logistic regression models to understand risk factors for 2 clinical outcomes, all-cause mortality during facility admission, and blood culture clearance.
Our cohort consisted of 187 patients with C. auris BSI (56.1% male, 55.6% age >65 years); 54.6% died by facility discharge and 66.9% (of 142 with available data) experienced blood culture clearance. Pitt bacteremia score at infection onset was associated with mortality (odds ratio [95% confidence interval]: 1.19 [1.01-1.40] per 1-point increase). Hemodialysis was associated with a reduced odds of microbiologic clearance (0.15 [0.05-0.43]) and with mortality (3.08 [1.27-7.50]).
The Pitt bacteremia score at the onset of C. auris BSI may be a useful tool in identifying patients at risk for mortality. Targeted infection prevention practices in patients receiving hemodialysis may be useful to limit poor outcomes.
由于定植率的增加和侵袭性感染的报道，耳念珠菌已成为全球日益关注的问题。关于与耳念珠菌血流感染（BSI）患者不良结局相关的临床因素的数据有限。
我们在美国医疗保健环境中的 2 个地理区域组建了一个多中心回顾性队列，纳入耳念珠菌 BSI 患者。我们收集了人口统计学、临床和微生物学特征的数据，以描述队列，并构建了多变量逻辑回归模型，以了解 2 个临床结局（住院期间全因死亡率和血培养清除率）的危险因素。
我们的队列包括 187 例耳念珠菌 BSI 患者（56.1%为男性，55.6%年龄>65 岁）；54.6%在出院时死亡，66.9%（142 例有可用数据）经历了血培养清除。感染起始时的 Pitt 菌血症评分与死亡率相关（优势比[95%置信区间]：每增加 1 分，为 1.19[1.01-1.40]）。血液透析与微生物清除率降低（0.15[0.05-0.43]）和死亡率（3.08[1.27-7.50]）相关。
耳念珠菌 BSI 起始时的 Pitt 菌血症评分可能是识别死亡风险患者的有用工具。针对接受血液透析患者的针对性感染预防措施可能有助于限制不良结局。
