Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections
Adequacy of empirical antifungal therapy and effect on outcome among patients with invasive Candida species infections
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DOI：
10.1093/jac/dkm212
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发表时间：
2007-09-01
影响因子：
5.2
通讯作者：
Laupland, Kevin B.
中科院分区：
文献类型：
--
作者：
Parkins, Michael D.;Sabuda, Deana M.;Laupland, Kevin B.
目的：虽然多项研究表明不适当的抗菌治疗会增加细菌感染的死亡风险，但很少有数据调查抗真菌治疗对严重真菌疾病结局的影响。我们试图评估经验治疗的充分性及其对侵袭性念珠菌感染的死亡率的影响。方法：对所有从血液和/或脑脊液中培养念珠菌的患者进行基于人群的监测。根据已发表的指南评估经验疗法的充分性。结果：5年期间，207例患者有侵袭性念珠菌感染；在199例（96%）病例中，有足够的数据可用于评估治疗和出院时的结果。白色念珠菌103例（52%），光秃念珠菌44例（22%），其他念珠菌所致。从培养画到报告阳性培养，只有64例（32%）患者接受了经验性治疗；51人（26%）认为这是足够的。接受充分经验性治疗的患者粗死亡率显著降低[14/51 (27%)vs . 68/148 (46%)；风险比0.60(95%置信区间0.37-0.96)；P = 0.02]。在logistic回归分析中调整了年龄和入住重症监护病房的需要后，使用充分的经验治疗与死亡风险降低独立相关[优势比0.46(95%可信区间0.22-1.00)；P = 0.05]。结论：在侵袭性念珠菌感染的少数患者中使用了充分的经验治疗，但与生存率的提高有关。
Objectives: Although inadequate antimicrobial therapy has been demonstrated in multiple studies to increase the risk for death in bacterial infections, few data investigating the effect of antifungal therapy on outcome of serious fungal disease are available. We sought to assess the adequacy of empirical therapy and its effect on mortality in invasive Candida species infections.Methods: Population-based surveillance of all patients with Candida spp. cultured from blood and/or cerebrospinal fluid was conducted. Adequacy of empirical therapy was assessed according to published guidelines.Results: During a 5 year period, 207 patients had an invasive Candida spp. infection identified; in 199 cases (96%) adequate data were available for assessment of treatment and outcome at hospital discharge. One hundred and three (52%) cases were due to Candida albicans, 44 (22%) were due to Candida glabrata and the remainder were due to other species. Between the time of culture draw and reporting of a positive culture, only 64 (32%) patients were treated with empirical therapy; this was deemed adequate in 51 (26%). Patients who received adequate empirical therapy had a significant decrease in crude mortality [14/51 (27%) versus 68/148 (46%); risk ratio 0.60 (95% confidence interval 0.37-0.96); P = 0.02]. After adjusting for age and the need for intensive care unit admission in logistic regression analysis, the use of adequate empirical therapy was independently associated with a reduced risk for death [odds ratio 0.46 ( 95% confidence interval 0.22-1.00); P = 0.05].Conclusions: Adequate empirical therapy is used in a minority of patients with invasive Candida spp. infections but is associated with improved survival.