合并和未合并新型冠状病毒肺炎的念珠菌血症患者的临床特征及结局比较：一项多中心回顾性研究
Comparison of clinical characteristics and outcomes in candidaemia patients with and without COVID-19: a multicentre retrospective study.
作者信息
Shin Sung Un, Bae Sohyun, Cho David, Lee Ahrang, Jeong Hae Seong, Hwang Soyoon, Kim Sarah, Kim Minji, Kim Seong Eun, Kim Uh Jin, Kang Seung-Ji, Park Kyung-Hwa, Chang Hyun-Ha, Jung Sook In
机构信息
Department of Infectious Disease, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong Ro, Donggu, Gwangju, 61469, South Korea.
Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130, Dongdeok‑ro, Jung‑gu, Daegu, 41944, South Korea.
出版信息
BMC Infect Dis. 2024 Dec 28;24(1):1473. doi: 10.1186/s12879-024-10373-5.
BACKGROUND
Invasive fungal infections have been reported as complications with significant mortality and morbidity in patients hospitalized with COVID-19. This study aimed to evaluate the clinical characteristics and outcomes of candidaemia patients with COVID-19 and to investigate the association between COVID-19 and mortality in candidaemia patients.
METHODS
This retrospective study included candidaemia patients aged 18 years or older admitted to four university-affiliated tertiary hospitals in South Korea between January 1, 2020, and December 31, 2022. The COVID-19 group comprised patients diagnosed with COVID-19 before the onset of candidaemia. Clinical features and outcomes were compared between the COVID-19 and non-COVID-19 groups. Multivariate logistic regression analyses were performed to identify risk factors related to 30-day mortality.
RESULTS
Of the 355 patients diagnosed with candidaemia, 39 (11.0%) had a prior diagnosis of COVID-19. The COVID-19 group exhibited greater rates of systemic corticosteroid use (20.5% vs. 8.9%, p = 0.042), central venous catheter use (74.4% vs. 57.3%, p = 0.041), and mechanical ventilation (53.8% vs. 31.6%, p = 0.006) before the onset of candidaemia. The COVID-19 group had a greater rate of septic shock at the onset of candidaemia (61.5% vs. 32.0%, p < 0.0001) and a greater 30-day mortality rate (69.2% vs. 50.9%, p = 0.031). K‒M survival analysis revealed that patients in the COVID-19 group had a lower 30-day survival rate than did those without COVID-19 (p = 0.003 by log-rank test). However, in multivariate logistic regression analysis, COVID-19 did not significantly impact 30-day mortality.
CONCLUSIONS
According to multivariate logistic regression analysis, COVID-19 was not an independent risk factor for mortality. However, candidaemia patients with a prior COVID-19 diagnosis were more likely to exhibit critical conditions such as mechanical ventilation and experience poor outcomes. Therefore, clinicians need to monitor and prevent candidaemia in critically ill patients with COVID-19.
背景
侵袭性真菌感染已被报道为新型冠状病毒肺炎（COVID-19）住院患者的并发症，具有较高的死亡率和发病率。本研究旨在评估合并COVID-19的念珠菌血症患者的临床特征和预后，并探讨COVID-19与念珠菌血症患者死亡率之间的关联。
方法
这项回顾性研究纳入了2020年1月1日至2022年12月31日期间在韩国四家大学附属医院收治的18岁及以上的念珠菌血症患者。COVID-19组包括在念珠菌血症发病前被诊断为COVID-19的患者。比较COVID-19组和非COVID-19组的临床特征和预后。进行多因素逻辑回归分析以确定与30天死亡率相关的危险因素。
结果
在355例诊断为念珠菌血症的患者中，39例（11.0%）先前被诊断为COVID-19。COVID-19组在念珠菌血症发病前全身使用皮质类固醇激素的比例更高（20.5%对8.9%，p = 0.042），中心静脉导管使用比例更高（74.4%对57.3%，p = 0.041），机械通气比例更高（53.8%对31.6%，p = 0.006）。COVID-19组在念珠菌血症发病时发生感染性休克的比例更高（61.5%对32.0%，p < 0.0001），30天死亡率更高（69.2%对50.9%，p = 0.031）。K-M生存分析显示，COVID-19组患者的30天生存率低于未感染COVID-19的患者（对数秩检验p = 0.003）。然而，在多因素逻辑回归分析中，COVID-19对30天死亡率没有显著影响。
结论
根据多因素逻辑回归分析，COVID-19不是死亡率的独立危险因素。然而，先前诊断为COVID-19的念珠菌血症患者更有可能出现如机械通气等危急情况，且预后较差。因此，临床医生需要对合并COVID-19的重症患者监测并预防念珠菌血症。
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