Epidemiology and Outcomes of Candidemia in 2019 Patients: Data from the Prospective Antifungal Therapy Alliance Registry
Epidemiology and Outcomes of Candidemia in 2019 Patients: Data from the Prospective Antifungal Therapy Alliance Registry
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DOI：
10.1086/599039
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发表时间：
2009-06-15
影响因子：
11.8
通讯作者：
Webster, Karen M.
中科院分区：
文献类型：
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作者：
Horn, David L.;Neofytos, Dionissios;Webster, Karen M.
背景念珠菌血症仍然是卫生保健环境中发病率和死亡率的主要原因，念珠菌感染的流行病学正在发生变化。念珠菌血症患者的临床数据来自前瞻性抗真菌治疗（PATH）联盟数据库，这是一个收集有关侵袭性真菌感染信息的综合登记处。从2004年7月1日到2008年3月5日，共识别了2019名患者。分析了念珠菌血症发作的相关数据，包括特定真菌种类和患者确诊后12周的生存率。非白色念珠菌引起的念珠菌血症发生率（54.4%）高于念珠菌引起的念珠菌血症。白色念珠菌占45.6%。总的12周粗死亡率为35.2%。近平滑念珠菌血症患者的死亡率最低（23.7%; P <0.001），与其他念珠菌感染的患者相比，患者更不容易出现血小板减少（5.1%; P <0.001），接受皮质类固醇（33.5%; P <0.001）或其他免疫抑制药物（7.9%; P = 0.002）。克柔念珠菌血症最常与既往使用抗真菌药物（70.6%; P < .001）、血液恶性肿瘤（52.9%; P < .001）或干细胞移植（17.7%; P < .001）、中性粒细胞减少（45.1%; P < .001）和皮质类固醇治疗（60.8%; P < .001）相关。C.克柔氏念珠菌血症患者的12周粗死亡率最高（52.9%; P <0.001）。氟康唑是最常用的抗菌药物，其次是棘白菌素类，而阿替霉素B类产品使用频率较低。念珠菌血症的流行病学和治疗选择正在迅速变化。进一步的研究是必要的，以区分宿主因素和念珠菌属物种之间的毒力差异，并确定最佳的治疗方案。
Background. Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing.Methods. Clinical data from patients with candidemia were extracted from the Prospective Antifungal Therapy (PATH) Alliance database, a comprehensive registry that collects information regarding invasive fungal infections. A total of 2019 patients, enrolled from 1 July 2004 through 5 March 2008, were identified. Data regarding the candidemia episode were analyzed, including the specific fungal species and patient survival at 12 weeks after diagnosis.Results. The incidence of candidemia caused by non-Candida albicans Candida species (54.4%) was higher than the incidence of candidemia caused by C. albicans (45.6%). The overall, crude 12-week mortality rate was 35.2%. Patients with Candida parapsilosis candidemia had the lowest mortality rate (23.7%; P < .001) and were less likely to be neutropenic (5.1%; P < .001) and to receive corticosteroids (33.5%; P < .001) or other immuno-suppressive drugs (7.9%; P = .002), compared with patients infected with other Candida species. Candida krusei candidemia was most commonly associated with prior use of antifungal agents (70.6%; P < .001), hematologic malignancy (52.9%; P < .001) or stem cell transplantation (17.7%; P < .001), neutropenia (45.1%; P < .001), and corticosteroid treatment (60.8%; P < .001). Patients with C. krusei candidemia had the highest crude 12-week mortality in this series (52.9%; P < .001). Fluconazole was the most commonly administered antimicrobial, followed by the echinocandins, and amphotericin B products were infrequently administered.Conclusions. The epidemiology and choice of therapy for candidemia are rapidly changing. Additional study is warranted to differentiate host factors and differences in virulence among Candida species and to determine the best therapeutic regimen.