Arslan Eyüp, Turan Deniz, Karaşahin Ömer, Çaydaşı Özge, Olçar Yıldız, Dilmen Tekin Melike, Adıyeke Esra, Yılmaz Karadağ Fatma, Öztürk Engin Derya
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Sancaktepe Şehit Prof Dr İlhan Varank Training and Research Hospital, Istanbul, Türkiye.
University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Laboratory of Medical Microbiology, Istanbul, Türkiye.
Infect Dis (Lond). 2025 Aug 19:1-15. doi: 10.1080/23744235.2025.2546482.
This study aims to compare risk factors and mortality of candidemia by versus non in intensive care units (ICU).
A total of 437 ICU patients who developed candidemia (90 , 143 , 204 other spp.) in 2021-2023 were included. The risk factors in candidemia caused by , and other spp. were compared. Factors associated with 30-day mortality in candidemia were explored.
Compared to the group, the group had more frequent ceftazidime avibactam use (OR:6.72, 95%CI: 1.29-34.98, = 0.024) and tracheostomy (OR:4.13, 95%CI: 1.70-10.02, = 0.002), longer colistin (OR:1.07, 95%CI: 1.01-1.13, = 0.021) and urinary catheter use (OR:1.02, 95%CI: 1.01-1.03, = 0.023). Compared to the other spp. group, colistin use (OR:2.79, 95%CI: 1.61-4.87, < 0.001), chronic obstructive pulmonary disease (OR:2.02, 95%CI: 1.05-3.90, = 0.036) and concurrent bacteraemia (OR:1.92, 95%CI: 1.06-3.48, = 0.030) were more frequent in the group. Rate of 30-day mortality was lower in patients (63.3%) compared to the (82.5%) and other spp. (75.5%) groups. While the 30-day mortality rate was higher in patients who received vasopressor therapy (OR:3.12, 95%CI: 1.78-5.47, < 0.001) and had high lactate levels (OR:1.41, 95%CI: 1.00-1.99, = 0.047) and low platelet counts (OR:1.00, 95%CI: 0.99-1.00, = 0.003) on the first day of candidemia, it was lower in patients with microbiologic response (OR:0.03, 95%CI: 0.01-0.09, < 0.001).
The necessity of broad-spectrum antibiotics and indwelling catheters should be routinely reassessed to reduce candidemia. Lower mortality was linked to microbiologic response; thus, fungal eradication should be prioritised in clinical practice.
本研究旨在比较重症监护病房（ICU）中白色念珠菌血症与非白色念珠菌血症的危险因素及死亡率。
纳入2021年至2023年期间在ICU发生念珠菌血症的437例患者（90例白色念珠菌，143例非白色念珠菌，204例其他念珠菌属）。比较白色念珠菌、非白色念珠菌及其他念珠菌属引起念珠菌血症的危险因素。探讨白色念珠菌血症患者30天死亡率的相关因素。
与非白色念珠菌组相比，白色念珠菌组头孢他啶阿维巴坦使用更频繁（比值比：6.72，95%置信区间：1.29 - 34.98，P = 0.024）、气管切开更频繁（比值比：4.13，95%置信区间：1.70 - 10.02，P = 0.002）、多黏菌素使用时间更长（比值比：1.07，95%置信区间：1.01 - 1.13，P = 0.021）及导尿管使用时间更长（比值比：1.02，95%置信区间：|1.01 - 1.03，P = 0.023）。与其他念珠菌属组相比，白色念珠菌组多黏菌素使用更频繁（比值比：2.79，95%置信区间：1.61 - 4.87，P < 0.001）、慢性阻塞性肺疾病更常见（比值比：2.02，95%置信区间：1.05 - 3.90，P = 0.036）及合并菌血症更常见（比值比：1.92，95%置信区间：1.06 - 3.48，P = 0.030）。白色念珠菌血症患者的30天死亡率（63.3%）低于非白色念珠菌组（82.5%）和其他念珠菌属组（75.5%）。白色念珠菌血症首日接受血管活性药物治疗（比值比：3.12，95%置信区间：1.78 - 5.47，P < 0.001）、乳酸水平高（比值比：1.41，95%置信区间：1.00 - 1.99，P = 0.047）及血小板计数低（比值比：1.00，95%置信区间：0.99 - 1.00，P = 0？003）的患者30天死亡率较高，而有微生物学反应的患者死亡率较低（比值比：0.03，95%置信区间：0.01 - 0.09，P < 0.001）。
应定期重新评估广谱抗生素和留置导管的必要性以减少白色念珠菌血症。较低的死亡率与微生物学反应相关；因此，临床实践中应优先根除真菌。
