Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients
Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients
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DOI：
10.1111/myc.13332
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发表时间：
2021-06-16
期刊：
影响因子：
4.9
通讯作者：
Guner, Rahmet
中科院分区：
文献类型：
--
作者：
Kayaaslan, Bircan;Eser, Fatma;Guner, Rahmet
重症监护病房中严重的新冠肺炎患者由于暴露于多种念珠菌血症危险因素，其发生念珠菌血症的风险较高。目的比较应用新冠肺炎与不使用新冠肺炎的ICU患者念珠菌血症的发生率，探讨念珠菌血症患者的流行病学和临床特征以及影响其死亡率的危险因素。这项回顾性研究是在安卡拉市医院ICU的患者中进行的，跟踪时间为2年，分为大流行前和大流行期间。比较新冠肺炎组和非新冠肺炎组念珠菌血症的发生率(每1000患者日发生事件)、流行病学以及患者的临床和实验室特征。新冠肺炎组白念珠菌感染率(2.16，95%CI1.77-2.60)高于非新冠肺炎组(1.06，95%CI0.89-0.125)(p<；.001)。在研究期间，总共检测到236次念珠菌血症(105例发生在新冠肺炎患者中，131例发生在非新冠肺炎患者中)。新冠肺炎患者的皮质类固醇使用率较高(63.8%vs.9.9%，p<；.001)。念珠菌血症的流行病学和抗真菌敏感性相似。新冠肺炎组白念珠菌感染发病时间提前2周，死亡率较高(92.5%vs.79.4%，p.005)。三分之一的念珠菌血症患者在接受任何抗真菌治疗之前死亡，这一比例在新冠肺炎组更高。在多因素Logistic回归分析中，皮质类固醇的使用、脓毒症的存在和年龄大于65岁是影响念珠菌血症患者死亡率的独立危险因素。白念珠菌血症发病率高、发生早、病死率高，死亡率高，是新冠肺炎患者较为严重的问题。
Severe COVID-19 patients in ICU are at high risk for candidemia due to exposure to multiple risk factors for candidemia. We aimed to compare the incidence of candidemia in ICU patients with and without COVID-19, and to investigate epidemiologic and clinical characteristics of candidemia patients and risk factors for mortality in candidemia patients. This retrospective study was conducted in patients followed in the ICUs of Ankara City Hospital for 2 years, divided into pre-pandemic and pandemic periods. The incidence (event per 1000 patient-days) and epidemiology of candidemia, clinical and laboratory characteristics of patients were compared in COVID-19 and non-COVID-19 groups. Candidemia incidence was higher in the COVID-19 group (2.16, 95% CI 1.77-2.60) than the non-COVID-19 group (1.06, 95% CI 0.89-0.125) (p < .001). A total of 236 candidemia episodes (105 in COVID-19 patients and 131 in non-COVID-19 patients) were detected during the study periods. COVID-19 cases had a higher rate of corticosteroid use (63.8% vs. 9.9%, p < .001). Epidemiology of candidemia and antifungal susceptibility were similar. Candidemia developed 2 weeks earlier in COVID-19 groups and resulted in higher mortality (92.5% vs. 79.4%, p .005). One-third of candidemia patients died before receiving any antifungal treatment, and this rate was higher in the COVID-19 group. In multivariate logistic regression analysis, corticosteroid use, presence of sepsis and age older than 65 years were independent risk factors for mortality in candidemia patients. Candidemia with high mortality is a more serious problem for COVID-19 patients due to its increased incidence, earlier occurrence and a higher rate of mortality.