Suárez-Urquiza Pedro, Pemán Javier, Gordon Monica, Favier Patricio, Muñoz-Brell Paula, López-Hontangas Jose Luis, Ruiz-Gaitán Alba
Department of Medical Microbiology, University and Polytechnic La Fe Hospital, 46026 Valencia, Spain.
Severe Infection Research Group, Health Research Institute La Fe, 46026 Valencia, Spain.
J Fungi (Basel). 2024 Sep 27;10(10):674. doi: 10.3390/jof10100674.
Fungemia remains a major threat in intensive care units (ICUs), with high mortality rates despite advances in diagnostics and treatment. Colonisation by yeasts is an independent risk factor for fungemia; however, its predictive utility requires further research. In this 8-year study, we analysed 38,017 samples from 3206 patients and 171 fungemia episodes as part of a weekly fungal surveillance programme. We evaluated species-specific colonisation patterns, the predictive value of the Colonisation Index (CI) and Corrected Colonisation Index (CCI), and candidemia risks associated with different yeast species and anatomical site colonisation. Our results showed that , , and colonisation increased with longer hospital stays (0.8% to 11.55%, 8.13% to 16.8%, and 1.93% to 5.14%, respectively). The CI and CCI had low discriminatory power (AUROC 67% and 66%). Colonisation by any yeast genera demonstrated high sensitivity (98.32%) and negative predictive value (NPV) (95.90%) but low specificity and positive predictive value (PPV) (23.90% and 6.64%). Tracheal and urine cultures had the highest PPV (15.64% and 12.91%), while inguinal cultures had the highest NPV (98.60%). (12.32%) and (5.5%) were associated with a higher fungemia risk (log-rank < 0.001). These findings support the use of weekly surveillance to better stratify the fungemia risk and optimise antifungal use in ICUs.
真菌血症仍然是重症监护病房（ICU）中的一个主要威胁，尽管诊断和治疗取得了进展，但死亡率仍然很高。酵母菌定植是真菌血症的一个独立危险因素；然而，其预测效用还需要进一步研究。在这项为期8年的研究中，作为每周真菌监测计划的一部分，我们分析了来自3206名患者的38017份样本和171例真菌血症发作情况。我们评估了特定菌种的定植模式、定植指数（CI）和校正定植指数（CCI）的预测价值，以及与不同酵母菌种和解剖部位定植相关的念珠菌血症风险。我们的结果表明， 、 和 的定植率随着住院时间延长而增加（分别从0.8%增至11.55%、8.13%增至16.8%、1.93%增至5.14%）。CI和CCI的鉴别能力较低（曲线下面积分别为67%和66%）。任何酵母属的定植都表现出高敏感性（98.32%）和阴性预测值（NPV）（95.90%），但特异性和阳性预测值（PPV）较低（分别为23.90%和6.64%）。气管和尿液培养的PPV最高（分别为15.64%和12.91%），而腹股沟培养的NPV最高（98.60%）。 （12.32%）和 （5.5%）与较高的真菌血症风险相关（对数秩检验<0.001）。这些发现支持通过每周监测来更好地分层真菌血症风险，并优化ICU中的抗真菌药物使用。
