Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Mycoses. 2024 Oct;67(10):e13798. doi: 10.1111/myc.13798.
The epidemiology and clinical impact of COVID-19-associated candidemia (CAC) remained uncertain, leaving gaps in understanding its prevalence, risk factors and outcomes.
A systematic review and meta-analysis were conducted by searching PubMed, Embase and Scopus for reports of CAC prevalence, risk factors and clinical outcomes up to June 18, 2024. The generalised linear mixed model was employed to determine the prevalence and 95% confidence intervals (CIs). The risk factors and clinical outcomes were compared between patients with and without CAC using the inverse variance method.
From 81 studies encompassing 29 countries and involving 351,268 patients, the global prevalence of CAC was 4.33% (95% Cl, 3.16%-5.90%) in intensive care unit (ICU) patients. In ICUs, the pooled prevalence of CAC in high-income countries was significantly higher than that of lower-middle-income countries (5.99% [95% Cl, 4.24%-8.40%] vs. 2.23% [95% Cl, 1.06%-4.61%], p = 0.02). Resistant Candida species, including C. auris, C. glabrata (Nakaseomyces glabratus) and C. krusei (Pichia kudriavzveii), constituted 2% of ICU cases. The mortality rate for CAC was 68.40% (95% Cl, 61.86%-74.28%) among ICU patients. Several risk factors were associated with CAC, including antibiotic use, central venous catheter placement, dialysis, mechanical ventilation, tocilizumab, extracorporeal membrane oxygenation and total parenteral nutrition. Notably, the pooled odds ratio of tocilizumab was 2.59 (95% CI, 1.44-4.65).
The prevalence of CAC is substantial in the ICU setting, particularly in high-income countries. Several risk factors associated with CAC were identified, including several that are modifiable, offering the opportunity to mitigate the risk of CAC.
COVID-19 相关念珠菌血症（CAC）的流行病学和临床影响仍不确定，因此对其患病率、危险因素和结局的了解存在空白。
系统检索 PubMed、Embase 和 Scopus 中截至 2024 年 6 月 18 日关于 CAC 患病率、危险因素和临床结局的报告，采用广义线性混合模型确定患病率和 95%置信区间（CI）。采用逆方差法比较 CAC 患者和非 CAC 患者的危险因素和临床结局。
共纳入 81 项来自 29 个国家的研究，涉及 351268 例患者，ICU 患者 CAC 的全球患病率为 4.33%（95%CI，3.16%-5.90%）。在 ICU 中，高收入国家 CAC 的患病率明显高于中低收入国家（5.99%[95%CI，4.24%-8.40%]比 2.23%[95%CI，1.06%-4.61%]，p=0.02）。耐氟康唑的念珠菌属，包括 C.auris、C.glabrata（Nakaseomyces glabratus）和 C.krusei（Pichia kudriavzveii），占 ICU 病例的 2%。CAC 在 ICU 患者中的死亡率为 68.40%（95%CI，61.86%-74.28%）。一些危险因素与 CAC 相关，包括抗生素使用、中心静脉导管放置、透析、机械通气、托珠单抗、体外膜氧合和全胃肠外营养。值得注意的是，托珠单抗的汇总优势比为 2.59（95%CI，1.44-4.65）。
CAC 在 ICU 环境中患病率较高，特别是在高收入国家。确定了与 CAC 相关的一些危险因素，包括一些可改变的危险因素，为降低 CAC 的风险提供了机会。
