Clinical characteristics of candidaemia in adults with haematological malignancy, and antimicrobial susceptibilities of the isolates at a medical centre in Taiwan, 2001-2010
Clinical characteristics of candidaemia in adults with haematological malignancy, and antimicrobial susceptibilities of the isolates at a medical centre in Taiwan, 2001-2010
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DOI：
10.1016/j.ijantimicag.2012.07.022
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发表时间：
2012-12-01
影响因子：
10.8
通讯作者：
Hsueh, Po-Ren
中科院分区：
文献类型：
--
作者：
Chen, Chien-Yuan;Huang, Shang-Yi;Hsueh, Po-Ren
在2001-2010年间，在国立台湾大学医院(台湾台北)的2574名血液恶性肿瘤患者中，共有111人发生了154次念珠菌血症。急性淋巴细胞性白血病患者的念珠菌血症发生率显著高于其他血液系统恶性肿瘤患者(优势比=2.69；P<；0.001)。最常见的念珠菌是热带念珠菌(n=51，46%)，其次是白色念珠菌(n=35，32%)、近缘念珠菌(n=13，12%)、光滑念珠菌(n=8，7%)和克鲁斯假丝酵母菌(n=4，4%)。持续性念珠菌血症最初发现21例(18.9%)，并经常与中心静脉导管相关感染有关(52%对24%；P=0.017)。多因素分析显示休克(P<；0.001)、异基因移植(P=0.033)和高龄(P=0.041)是影响恶性血液病和念珠菌血症患者30天总生存期的独立预后因素。用微量肉汤稀释法测定了103株念珠菌对9种抗真菌药物的最低抑菌浓度(MIC)。103株念珠菌对伊曲康唑、氟康唑和伏立康唑的敏感性分别为53株(51.5%)、94株(91.3%)和102株(99.0%)。所有念珠菌对卡泊芬净敏感，13株近缘念珠菌中有2株(15%)对米卡芬净或阿尼达芬净不敏感。泊沙康唑对白色念珠菌的MIC90为0.03 mg/L，热带念珠菌的MIC90为0.5 mg/L，巴氏念珠菌的MIC90为0.12 mg/L，光滑念珠菌的MIC90为2 mg/L。(C)2012年爱思唯尔公司和国际化疗学会。版权所有。
During the period 2001-2010, a total of 154 episodes of candidaemia were noted in 111 of 2574 patients with haematological malignancies at the National Taiwan University Hospital (Taipei, Taiwan). Patients with acute lymphoblastic leukaemia had a significantly higher rate of candidaemia than patients with other haematological malignancies (odds ratio = 2.69; P < 0.001). Candida tropicalis was the most common Candida species (n = 51; 46%), followed by Candida albicans (n = 35; 32%), Candida parapsilosis (n = 13; 12%), Candida glabrata (n = 8; 7%) and Candida krusei (n = 4; 4%). Persistent candidaemia was initially identified in 21 patients (18.9%) and was frequently associated with central venous catheter-related infection (52% vs. 24%; P = 0.017). Multivariate analysis revealed that shock (P < 0.001), allogeneic transplantation (P = 0.033) and elderly age (>= 60 years) (P = 0.041) were independent prognostic factors of 30-day overall survival in patients with haematological malignancy and candidaemia. Minimum inhibitory concentrations (MICs) of a total of 103 non-duplicate blood isolates of Candida spp., including 82 isolates from 82 patients without persistent candidaemia and 21 isolates causing first episodes among 21 patients with persistent candidaemia, to nine antifungal agents were determined using the broth microdilution method. Among the 103 Candida isolates, 53 (51.5%), 94 (91.3%) and 102 (99.0%) were susceptible to itraconazole, fluconazole and voriconazole, respectively. All Candida isolates were susceptible to caspofungin, and 2 (15%) of the 13 C. parapsilosis isolates were not susceptible to micafungin or anidulafungin. The MIC90 (MIC for 90% of the organisms) of posaconazole was 0.03 mg/L for C. albicans, 0.5 mg/L for C. tropicalis, 0.12 mg/L for C. parapsilosis and 2 mg/L for C. glabrata. (C) 2012 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved.