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住院成年患者尿路感染的短疗程与长疗程抗真菌治疗评估

Evaluation of shorter versus longer antifungal treatment durations for . urinary tract infections among hospitalized adults.

作者信息

Govel Jacob C, Seabury Robert W, Asiago-Reddy Elizabeth A, Gutierrez Ramiro L, Parsels Katie A, Kufel Wesley D

机构信息

State University of New York at Binghamton School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA.

State University of New York Upstate University Hospital, Syracuse, New York, USA.

出版信息

Antimicrob Agents Chemother. 2025 Jun 4;69(6):e0192024. doi: 10.1128/aac.01920-24. Epub 2025 Apr 22.

Abstract

Infectious Diseases Society of America guidelines recommend 14 days of treatment for . urinary tract infections (UTIs). To our knowledge, no data are available to compare <14 days for . UTI. This was a single-center, retrospective cohort study between 01 January 2015 and 01 January 2024. Hospitalized adults with 1 urine culture with . and symptoms who initiated >1 antifungal dose within 96 hours were included. Multiple exclusion criteria existed, including but not limited to if . were isolated from another site, antifungals were received for another indication, or the participant was asymptomatic. The primary outcome was clinical treatment success. Binary logistic regression was performed to further assess the relationship between fluconazole duration and clinical treatment success. Among 2,400 patients with candiduria, 45 and 58 in the 14-day and <14-day cohorts were assessed after exclusion criteria were applied, respectively. Median (interquartile range) fluconazole duration was 14 (14-14) days in the 14-day cohort and 7 (5-7) in the <14-day cohort. There was no difference in clinical treatment success in patients treated for 14 days vs <14 days (14 days: 93.3% (42/45) vs <14 days: 93.1% (54/58), = 1.000; between-group difference (95% CI: 0.02 [-9.6 to 10]). Fluconazole duration did not have a significant association with clinical treatment success on binary logistic regression ( = 0.503; odds ratio 0.917 [95% CI: 0.712-1.181]). There was no statistically significant difference in clinical treatment success in patients treated with fluconazole for a median of 14 days vs a median of 7 days for symptomatic . UTI. These data support the potential utility of shorter antifungal durations for . UTI.

摘要

美国传染病学会指南推荐对尿路感染(UTIs)进行14天的治疗。据我们所知,尚无数据可用于比较治疗UTI少于14天的情况。这是一项于2015年1月1日至2024年1月1日期间开展的单中心回顾性队列研究。纳入了在96小时内开始使用超过1剂抗真菌药物且有1次尿培养阳性及症状的住院成人患者。存在多项排除标准,包括但不限于是否从其他部位分离出(病原体)、是否因其他指征接受抗真菌治疗或参与者是否无症状。主要结局是临床治疗成功。进行二元逻辑回归以进一步评估氟康唑治疗时长与临床治疗成功之间的关系。在2400例念珠菌尿患者中,分别应用排除标准后,14天和少于14天队列中分别有45例和58例患者接受评估。14天队列中氟康唑治疗时长的中位数(四分位间距)为14(14 - 14)天,少于14天队列中为7(5 - 7)天。治疗14天与少于14天的患者在临床治疗成功方面无差异(14天:93.3%(42/45),少于14天:93.1%(54/58),P = 1.000;组间差异(95% CI:0.02 [-9.6至10])。在二元逻辑回归中,氟康唑治疗时长与临床治疗成功无显著关联(P = 0.503;优势比0.917 [95% CI:0.712 - 1.181])。对于有症状的UTI,接受氟康唑治疗中位数为14天与中位数为7天的患者在临床治疗成功方面无统计学显著差异。这些数据支持了缩短抗真菌治疗时长用于UTI的潜在效用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1d46/12135507/339166be37c6/aac.01920-24.f001.jpg

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