Effect of Nebulized Amphotericin B in Critically ill Patients With Respiratory Candida spp. De-colonization: A Retrospective Analysis.
Effect of Nebulized Amphotericin B in Critically ill Patients With Respiratory Candida spp. De-colonization: A Retrospective Analysis.
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雾化两性霉素 B 对呼吸道念珠菌危重患者的影响非殖民化：回顾性分析。
DOI：
10.3389/fmed.2021.723904
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发表时间：
2021
影响因子：
3.9
通讯作者：
Liu J
中科院分区：
文献类型：
--
作者：
Du H;Wei L;Li W;Huang B;Liu Y;Ye X;Zhang S;Wang T;Chen Y;Chen D;Liu J
呼吸道念珠菌之间的潜在关系。尚未充分研究重症患者中的去定植、雾化阿替霉素B（NA B）和呼吸机相关性肺炎（VAP）的发生，特别是关于对存活率的影响。在这项观察性、回顾性、队列研究中，我们纳入了年龄>18岁、需要机械通气（MV）>48小时、至少连续两次阳性念珠菌的患者。测试结果.将患者分为NAB和无NAB（对照）组。按照严格的标准进行1：1的倾向匹配，并进行多因素考克斯比例风险模型和多因素分析以评估NAB治疗的效果。在整个8年的研究期间，526例患者接受了MV，并有阳性呼吸道念珠菌属。cultures.其中，我们纳入了275例患者，排除了251例患者。总的来说，我们成功匹配了两组的110例患者（每组n = 55;总人群中位年龄64岁;急性生理学和慢性健康评估II [APACHE II]评分25.5;序贯器官衰竭评估评分9）。述假丝酵母属NAB组的去定植率为69.1%。NAB组（10.91%）和对照组（16.36%）的VAP发生率无显著差异（P = 0.405）。NAB组（10.91%）和对照组（25.45%）之间铜绿假单胞菌相关VAP发生率差异显著（P = 0.048）。NAB组有5例（9.1%）患者在住院期间死亡，而对照组有17例（30.9%）（P = 0.014）。第28天时，NAB组和对照组分别有9例（16.4%）和16例（29.1%）死亡（P = 0.088）。两组之间的累积90天死亡率差异显著（23.6% vs. 43.6%，P = 0.015）。多变量logistic回归分析表明NAB组90天死亡率降低（调整后比值比0.413; 95%置信区间0.210-0.812; P = 0.01）。在亚组分析中，NAB相关的90天死亡风险降低在念珠菌评分为2、年龄较小（<64岁）、APACHE II评分较高（≥25）、念珠菌部位较少（<2）或入院时MV的患者亚组中是一致的。NAB处理有助于念珠菌属。气道去定植与铜绿假单胞菌相关VAP的风险降低相关，并改善念珠菌属危重患者的90天死亡率。接受MV>2天的气管支气管定植。NAB可能是VAP危重患者的替代治疗选择。
The potential relationship among airway Candida spp. de-colonization, nebulized amphotericin B (NAB), and occurrence of ventilator-associated pneumonia (VAP) in patients who are critically ill has not been fully investigated, especially concerning effects on survival. In this observational, retrospective, cohort study in a 22-bed central intensive care unit, we included patients aged >18 years who required mechanical ventilation (MV) for >48 h, with at least two consecutive positive Candida spp. test results. Patients were categorized into NAB and no NAB (control) groups. Propensity matching at 1:1 was performed according to strict standards, and multiple Cox proportional hazard model and multivariate analyses were performed to evaluate the effects of NAB treatment. Throughout an 8-year study period, 526 patients had received MV and had positive respiratory tract Candida spp. cultures. Of these, we included 275 patients and excluded 251 patients. In total, we successfully matched 110 patients from the two groups (each group, n = 55; total population median age, 64 years; Acute Physiology and Chronic Health Evaluation II [APACHE II] score, 25.5; sequential organ failure assessment score, 9). The Candida spp. de-colonization rate was 69.1% in patients treated with NAB. VAP incidence did not differ significantly between the NAB (10.91%) and control (16.36%) groups (P = 0.405). Pseudomonas aeruginosa-related VAP rates differed significantly between the NAB (10.91%) and control (25.45%) groups (P = 0.048). Five (9.1%) patients in the NAB group died during hospitalization compared with 17 (30.9%) controls (P = 0.014). At 28 days, 9 (16.4%) and 16 (29.1%) deaths occurred in the NAB and control groups, respectively, (P = 0.088). The cumulative 90-day mortality rate differed significantly between the two groups (23.6 vs. 43.6%, P = 0.015). Multivariate logistic regression analyses indicated a decreased 90-day mortality in the NAB group (adjusted odds ratio 0.413; 95% confidence interval 0.210–0.812; P = 0.01). In subgroup analyses, the NAB-associated decreased risk of death at 90 days was consistent across subgroups of patients with a Candida score of 2, younger age (<64 years), a higher APACHE II score (≥25), fewer Candida sites (<2), or MV at admission. NAB treatment contributed to Candida spp. airway de-colonization, was associated with a reduced risk of P. aeruginosa-related VAP, and improved 90-day mortality in patients critically ill with Candida spp. tracheobronchial colonization who had received MV for >2 days. NAB may be an alternative treatment option for critically ill patients with VAP.
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DOI：
10.1186/s13054-021-03484-x
发表时间：
2021-02-02
期刊：
Critical care (London, England)
影响因子：
--
作者：
He Q;Wang W;Zhu S;Wang M;Kang Y;Zhang R;Zou K;Zong Z;Sun X
通讯作者：
Sun X
影响因子：
38.9
作者：
Hamet, Mael;Pavon, Arnaud;Charles, Pierre-Emmanuel
通讯作者：
Charles, Pierre-Emmanuel
影响因子：
3.7
作者：
Panpetch W;Somboonna N;Bulan DE;Issara-Amphorn J;Finkelman M;Worasilchai N;Chindamporn A;Palaga T;Tumwasorn S;Leelahavanichkul A
通讯作者：
Leelahavanichkul A
影响因子：
9.6
作者：
Azoulay, E;Timsit, JF;Schlemmer, B
通讯作者：
Schlemmer, B
DOI：
10.1164/ajrccm.156.2.9612023
发表时间：
1997-08-01
影响因子：
24.7
作者：
ElEbiary, M;Torres, A;deAnta, MTJ
通讯作者：
deAnta, MTJ