Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained:: a potential risk factor for hospital mortality
Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained:: a potential risk factor for hospital mortality
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DOI：
10.1128/aac.49.9.3640-3645.2005
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发表时间：
2005-09-01
影响因子：
4.9
通讯作者：
Kollef, MH
中科院分区：
文献类型：
--
作者：
Morrell, M;Fraser, VJ;Kollef, MH
真菌血流感染与显着的患者死亡率和医疗保健费用相关。然而，延迟初始经验性抗真菌治疗直到知道血培养结果与临床结果之间的关系尚未明确。对巴恩斯犹太医院的自动化患者病历和药房数据库进行了回顾性队列分析。 4 年期间（2001 年 1 月至 2004 年 12 月）共鉴定出 157 名患有念珠菌血流感染的患者。 50 名（31.8%）患者在住院期间死亡。 134 名患者在真菌培养结果得知后开始接受经验性抗真菌治疗。自首次抽取培养阳性血样起，12小时内接受抗真菌治疗的患者有9例（5.7%），12~24小时内接受抗真菌治疗的患者有10例（6.4%），24~48小时内接受抗真菌治疗的患者有86例（54.8%），48小时后接受抗真菌治疗的患者有52例（33.1%）。多元逻辑回归分析确定了急性生理学和慢性健康评估 11 分（1 分增量）（调整优势比 [AOR]，1.24；95% 置信区间 [0]，1.18 至 1.31；P < 0.001）、既往抗生素治疗（AOR，4.05；95% CI，2.14 至 7.65；P = 0.028），以及第一个血样培养呈阳性后 12 小时给予抗真菌治疗（AOR，2.09；95% C1，1.53 至 2.84；P = 0.018）作为医院死亡率的独立决定因素。在抽取培养阳性血样 12 小时后进行经验性抗真菌治疗在念珠菌血流感染患者中很常见，并且与较高的医院死亡率相关。通过开发更快速的诊断技术来识别念珠菌血流感染，可以最大限度地减少念珠菌血流感染的延迟治疗。另外，对特定的真菌血流感染高风险患者增加经验性抗真菌治疗也可以减少治疗延误。
Fungal bloodstream infections are associated with significant patient mortality and health care costs. Nevertheless, the relationship between a delay of the initial empiric antifungal treatment until blood culture results are known and the clinical outcome is not well established. A retrospective cohort analysis with automated patient medical records and the pharmacy database at Barnes-Jewish Hospital was conducted. One hundred fifty-seven patients with a Candida bloodstream infection were identified over a 4-year period (January 2001 through December 2004). Fifty (31.8%) patients died during hospitalization. One hundred thirty-four patients had empiric antifungal treatment begun after the results of fungal cultures were known. From the time that the first blood sample for culture that was positive was drawn, 9 (5.7%) patients received antifungal treatment within 12 h, 10 (6.4%) patients received antifungal treatment between 12 and 24 h, 86 (54.8%) patients received antifungal treatment between 24 and 48 h, and 52 (33.1%) patients received antifungal treatment after 48 h. Multiple logistic regression analysis identified Acute Physiology and Chronic Health Evaluation 11 scores (one-point increments) (adjusted odds ratio [AOR], 1.24; 95% confidence interval [0], 1.18 to 1.31; P < 0.001), prior antibiotic treatment (AOR, 4.05; 95% CI, 2.14 to 7.65; P = 0.028), and administration of antifungal treatment 12 h after having the first positive blood sample for culture (AOR, 2.09; 95% C1, 1.53 to 2.84; P = 0.018) as independent determinants of hospital mortality. Administration of empiric antifungal treatment 12 h after a positive blood sample for culture is drawn is common among patients with Candida bloodstream infections and is associated with greater hospital mortality. Delayed treatment of Candida bloodstream infections could be minimized by the development of more rapid diagnostic techniques for the identification of Candida bloodstream infections. Alternatively, increased use of empiric antifungal treatment in selected patients at high risk for fungal bloodstream infection could also reduce delays in treatment.