癌症患者腹腔内念珠菌病：中等收入国家 10 年经验。

Intra-Abdominal Candidiasis in Cancer Patients: A 10-Year Experience in a Middle-Income Country.

机构信息

Instituto do Cancer do Estado de Sao Paulo, School of Medicine, Hospital Infection Control and Infectious Diseases Service, University of São Paulo, São Paulo, Brazil.

Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil.

出版信息

Mycoses. 2024 Oct;67(10):e13807. doi: 10.1111/myc.13807.

DOI:10.1111/myc.13807

PMID:39455432

Abstract

BACKGROUND

Invasive candidiasis (IC) represents a significant threat to both mortality and morbidity, especially among vulnerable populations. Intra-abdominal candidiasis (IAC) frequently occurs in critically ill and cancer patients, with these specific groups carrying a heightened risk for such invasive fungal infections. Despite this, there is a noticeable lack of attention to IAC in cancer patients within the literature, highlighting a critical gap that requires urgent consideration.

OBJECTIVES

This study aimed to explore the clinical and epidemiological characteristics of IAC and identify prognostic factors in a cancer centre in a middle-income country over 10 years.

PATIENTS/METHODS: A retrospective cohort observational study of adults diagnosed with IAC was conducted at the Instituto do Cancer do Estado de São Paulo (ICESP), a tertiary hospital specialising in oncological diseases with 499 beds, including 85 intensive care unit (ICU) beds, from December 2009 through May 2021.

RESULTS

A total of 128 episodes were included: 67.2% admitted to the ICU; 54.7% males; and median age 62 years. The predominant diagnosis was peritonitis (75.8%). Blood culture samples were collected from 128 patients upon admission, revealing candidemia in 17.2% (22). The most frequently isolated were C. albicans (n = 65, 50.8%) and C. glabrata (n = 42, 32.8%). Antifungal treatment was administered to 91 (71%) patients, with fluconazole (64.8%) and echinocandins (23.4%) being the most common choices. A significant proportion of these patients had a history of abdominal surgery or antibiotic use. Independent factors associated with 30-day mortality included the median Sequential Organ Failure Assessment (SOFA) score of 6 (OR = 1.30, 95% CI 1.094-1.562, p = 0.003), days of treatment (median 10.5) (OR = 0.93, 95% CI 0.870-0.993, p = 0.031) and abdominal source control (78.1%) (OR = 0.148, 95% CI 0.030-0.719, p = 0.018). The 30-day mortality rate was 41.1%.

CONCLUSIONS

Our study underscores the critical importance of implementing effective source control as a key strategy for reducing mortality in IAC.

摘要

背景

侵袭性念珠菌病（IC）对死亡率和发病率构成重大威胁，尤其是对弱势群体。腹腔内念珠菌病（IAC）常发生于重症和癌症患者中，这些特定群体罹患此类侵袭性真菌感染的风险更高。尽管如此，文献中对癌症患者中的 IAC 关注明显不足，这突显了一个亟待关注的关键空白。

目的

本研究旨在探讨 10 年间在一个中等收入国家的癌症中心中 IAC 的临床和流行病学特征，并确定其预后因素。

患者/方法：这是一项回顾性队列观察性研究，纳入了在圣保罗州癌症研究所（ICESP）确诊为 IAC 的成年患者。该研究所是一家拥有 499 张床位的三级肿瘤专科医院，包括 85 张重症监护病房（ICU）床位。研究时间为 2009 年 12 月至 2021 年 5 月。

结果

共纳入 128 例发作：67.2%的患者收治于 ICU；54.7%为男性；中位年龄为 62 岁。主要诊断为腹膜炎（75.8%）。在入院时采集了 128 名患者的血培养样本，发现有 17.2%（22 例）存在念珠菌血症。最常分离到的是白念珠菌（n=65，50.8%）和光滑念珠菌（n=42，32.8%）。91 例（71%）患者接受了抗真菌治疗，氟康唑（64.8%）和棘白菌素类（23.4%）是最常用的药物。这些患者中有相当一部分有腹部手术或抗生素使用史。与 30 天死亡率相关的独立因素包括中位序贯器官衰竭评估（SOFA）评分 6 分（比值比 [OR] 1.30，95%置信区间 [CI] 1.094-1.562，p=0.003）、治疗天数（中位数 10.5 天）（OR 0.93，95% CI 0.870-0.993，p=0.031）和腹部源头控制（78.1%）（OR 0.148，95% CI 0.030-0.719，p=0.018）。30 天死亡率为 41.1%。