Clinical Features, Strain Distribution, Antifungal Resistance and Prognosis of Patients with Non-albicans Candidemia: A Retrospective Observational Study.
Clinical Features, Strain Distribution, Antifungal Resistance and Prognosis of Patients with Non-albicans Candidemia: A Retrospective Observational Study.
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DOI：
10.2147/idr.s323583
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发表时间：
2021
影响因子：
3.9
通讯作者：
Zhang G
中科院分区：
文献类型：
--
作者：
Liu F;Zhong L;Zhou F;Zheng C;Zhang K;Cai J;Zhou H;Tang K;Dong Z;Cui W;Zhang G
白色念珠菌（C. albicans）念珠菌血症在以前的研究中已经得到了很好的报道，而对非白色念珠菌（NAC）血液感染的研究仍然很少。因此，本研究旨在探讨NAC念珠菌病患者的临床特点和预后。我们招募了一家三级医院2013年1月至2020年6月的住院念珠菌患者进行这项回顾性观察性研究。本研究共招募301例念珠菌病患者，其中161例（53.5%）为NAC念珠菌病患者。NAC念珠菌的主要病原菌为热带念珠菌（23.9%）、假丝酵母菌（15.6%）和光秃念珠菌（10.3%）。与白色念珠菌念珠菌患者相比，NAC念珠菌患者住院率更高（P=0.034），血液学恶性肿瘤比例更高（P=0.007），抗真菌暴露频率更高（P=0.012），留置外周中心导管的次数更多（P=0.002）。在多变量分析中，既往抗真菌暴露与NAC念珠菌血症独立相关（调整优势比[aOR]， 0.312； 95%可信区间[CI]， 0.113-0.859）。NAC对唑类具有明显抗性，特别是热带镰刀菌对唑类具有较高的交叉抗性。然而，两组在14天、28天和60天的死亡率没有显著差异。NAC在念珠菌中占主导地位，先前的抗真菌暴露是一个独立的危险因素。值得注意的是，尽管NAC与白色念珠菌念珠菌的结局相似，但NAC念珠菌患者对特异性唑类药物的耐药以及交叉耐药的情况较多，值得在临床实践中引起重视并进一步深入研究。
Candida albicans (C. albicans) candidemia has been well reported in previous studies, while research on non-albicans Candida (NAC) bloodstream infections remains poorly explored. Therefore, the present study aimed to investigate the clinical characteristics and outcomes of patients with NAC candidemia. We recruited inpatients with candidemia from January 2013 to June 2020 in a tertiary hospital for this retrospective observational study. A total of 301 patients with candidemia were recruited in the current study, including 161 (53.5%) patients with NAC candidemia. The main pathogens in NAC candidemia were Candida tropicalis (C. tropicalis) (23.9%), Candida parapsilosis (15.6%) and Candida glabrata (10.3%). Patients with NAC candidemia had more medical admissions (P=0.034), a higher percentage of hematological malignancies (P=0.007), a higher frequency of antifungal exposure (P=0.012), and more indwelling peripherally inserted central catheters (P=0.002) than those with C. albicans candidemia. In a multivariable analysis, prior antifungal exposure was independently related to NAC candidemia (adjusted odds ratio [aOR], 0.312; 95% confidence interval [CI], 0.113–0.859). Additionally, NAC was obviously resistant to azoles, especially C. tropicalis had a high cross-resistance to azoles. However, no significant differences were noted in the mortality rates at 14 days, 28 days and 60 days between these two groups. NAC is dominant in candidemia, and prior antifungal exposure is an independent risk factor. Of note, although the outcomes of NAC and C. albicans candidemia are similar, drug resistance to specific azoles as well as cross-resistance frequently occurs in patients with NAC candidemia, and this drug resistance deserves attention in clinical practice and further in-depth investigation.