Reduction in Percentage of Clusters of Candida albicans and Candida parapsilosis Causing Candidemia in a General Hospital in Madrid, Spain
Reduction in Percentage of Clusters of Candida albicans and Candida parapsilosis Causing Candidemia in a General Hospital in Madrid, Spain
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DOI：
10.1128/jcm.00574-18
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发表时间：
2018-07-01
影响因子：
9.4
通讯作者：
Guinea, Jesus
中科院分区：
文献类型：
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作者：
Escribano, Pilar;Sanchez-Carrillo, Carlos;Guinea, Jesus
在念珠菌血症高发的单位中存在簇群提示需要预防念珠菌血症。我们分析了在一个三级医院的患者参与集群的百分比和它的演变在很长一段时间。我们研究了2007年1月至2014年12月期间Gregorio Maranon医院收治的432例由白色念珠菌（n = 276）或近平滑念珠菌（n = 156）引起的念珠菌血症患者。对事件分离株进行基因分型。一个集群被定义为一组>2名患者被相同的基因型感染;当集群中涉及的患者在24个月内入住同一病房时，我们认为集群是“跟踪集群”。研究期间分为两个阶段，2007年至2010年（第1阶段）和2011年至2014年（第2阶段）。C.白色念珠菌和C.第2阶段的近平滑念珠菌血症（分别为n = 262和n = 170）、平均发病率（分别为1.62和1.36次发作/1,000例入院）和由群集引起的发作百分比（分别为总体群集[40%和12%]和跟踪群集[18%和3%]）均显著低于第1阶段。线性回归分析显示念珠菌血症的总发作次数与簇集引起的发作次数呈正相关（r（2）= 0.89）。我们发现由C.白色念珠菌和C.随着时间的推移，近平滑和集群引起的发作百分比下降。有趣的是，在减少的同时还开展了减少导管相关感染数量的运动。
The presence of clusters in units with a high incidence of candidemia suggests the need for the prevention of candidemia. We analyzed the percentage of patients involved in clusters and its evolution over a large period of time in a tertiary hospital. We studied 432 patients admitted to Gregorio Maranon Hospital with candidemia caused by Candida albicans (n = 276) or Candida parapsilosis (n = 156) between January 2007 and December 2014. Incident isolates were genotyped. A cluster was defined as a group of >2 patients infected by an identical genotype; we considered clusters to be "tracking clusters" when the patients involved in the cluster were admitted to the same ward within a period of 24 months. The study period was split into two periods, 2007 to 2010 (period 1) and 2011 to 2014 (period 2). The number of episodes of C. albicans and C. parapsilosis candidemia (n = 262 versus n = 170, respectively), the mean incidence (1.62 versus 1.36 episodes per 1,000 admissions, respectively), and the percentage of episodes caused by clusters (overall clusters [40% versus 12%] and tracking clusters [18% versus 3%], respectively) were significantly lower in period 2 than in period 1. Linear regression analysis showed a positive correlation between the overall number of episodes of candidemia and episodes caused by clusters (r(2) = 0.89). We found a reduction in the number of episodes of candidemia caused by C. albicans and C. parapsilosis and a decrease in the percentage of episodes caused by clusters over time. Interestingly, the reduction was accompanied by the implementation of a campaign to reduce the number of catheter-related infections.