法国注射吸毒者中的酵母菌血症（2012 - 2022年）：一项横断面观察性研究。

Yeast fungaemia among injection drug users in France (2012-2022): a cross-sectional observational study.

作者信息

Paccoud Olivier, Lortholary Olivier, Imbert Sebastien, Letscher-Bru Valerie, Boukris-Sitbon Karine, Obadia Thomas, Dalle Frederic, Hasseine Lilia, Morio Florent, Huguenin Antoine, Poirier Philippe, Favennec Loic, Bonhomme Julie, Alanio Alexandre, Lanternier Fanny, Desnos-Ollivier Marie

机构信息

Université Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker - Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, 75014, France.

Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Mycology Translational Research Group, Mycology Department, Paris, France.

出版信息

Lancet Reg Health Eur. 2025 Jun 25;55:101365. doi: 10.1016/j.lanepe.2025.101365. eCollection 2025 Aug.

DOI:10.1016/j.lanepe.2025.101365

PMID:40950950

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12426822/

Abstract

BACKGROUND

Intravenous injection drug use (IVDU) is an established but infrequent risk factor for yeast fungaemia. We aimed to identify features and outcomes of yeast fungaemia associated with IVDU in a nationwide surveillance network in France.

METHODS

We prospectively included episodes of yeast fungaemia in adults between 2012 and 2022. Episodes with any history of IVDU were considered IVDU-associated. We compared clinical characteristics, infecting species, antifungal treatments, and 90-day mortality between groups. We used Fisher's exact test for categorical variables and the Kruskal-Wallis test for continuous variables.

FINDINGS

We recorded 9549 episodes of yeast fungaemia among 9132 adults. Among these, 183 (1·9%) were IVDU-associated. Compared with non-IVDU, individuals with IVDU-associated fungaemia were younger and less likely to have a history of malignancy (13·8%, 20/145 49·5%, 4447/8987, p < 0·0001) or recent surgery (24·3%, 34/140 37·3%, 3261/8,733, p = 0·0014), and more likely to have deep-seated infections (14·5%, 21/145 3·4%, 307/8987, p < 0·0001). IVDU cases less often involved (30·1%, 55/183 47·6%, 4458/9366, p < 0·0001) and more often involved mixed-species infections (13·1%, 24/183 4·3%, 402/9366), p < 0·0001. and were overrepresented among IVDU cases (6·0%, 11/183 0·5%, 48/9366, p < 0·0001 and 5·5%, 10/183 0·05%, 5/9366, p < 0·0001, respectively). The crude 90-day case-fatality ratio was 20·7% (95% CI: 13·7%-29·2%) in the IVDU group versus 48·4% (95% CI: 47·3-49·5%) for non-IVDU.

INTERPRETATION

IVDU-associated yeast fungaemia presents distinct clinical and microbiological characteristics, highlighting the need for tailored diagnosis and management.

FUNDING

Financial support from Santé Publique France and Institut Pasteur, Paris.

摘要

背景

静脉注射吸毒（IVDU）是已知的但并不常见的酵母血症危险因素。我们旨在确定法国全国监测网络中与IVDU相关的酵母血症的特征和结局。

方法

我们前瞻性纳入了2012年至2022年期间成人的酵母血症发作病例。有任何IVDU病史的发作病例被视为与IVDU相关。我们比较了两组之间的临床特征、感染菌种、抗真菌治疗及90天死亡率。分类变量采用Fisher精确检验，连续变量采用Kruskal-Wallis检验。

结果

我们记录了9132名成人中的9549例酵母血症发作病例。其中，183例（1.9%）与IVDU相关。与非IVDU患者相比，与IVDU相关的真菌血症患者更年轻，患恶性肿瘤病史（13.8%，20/145对49.5%，4447/8987，p<0.0001）或近期手术史（24.3%，34/140对37.3%，3261/8733，p = 0.0014）的可能性更低，发生深部感染的可能性更高（14.5%，21/145对3.4%，307/8987，p<0.0001）。IVDU病例较少涉及白色念珠菌（30.1%，55/183对47.6%，4458/9366，p<0.0001），而更常涉及混合菌种感染（13.1%，24/183对4.3%，402/9366），p<0.0001。近平滑念珠菌和热带念珠菌在IVDU病例中占比过高（分别为6.0%，11/183对0.5%，48/9366，p<0.0001和5.5%，10/183对0.05%，5/9366，p<0.0001）。IVDU组的粗90天病死率为20.7%（95%CI：13.7%-29.2%），而非IVDU组为48.4%（95%CI：47.3-49.5%）。