CANDIDEMIA IN A TERTIARY CARE HOSPITAL - EPIDEMIOLOGY, RISK-FACTORS, AND PREDICTORS OF MORTALITY
CANDIDEMIA IN A TERTIARY CARE HOSPITAL - EPIDEMIOLOGY, RISK-FACTORS, AND PREDICTORS OF MORTALITY
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DOI：
10.1093/clind/15.3.414
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发表时间：
1992-09-01
影响因子：
11.8
通讯作者：
DUNAGAN, WC
中科院分区：
文献类型：
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作者：
FRASER, VJ;JONES, M;DUNAGAN, WC
对1988年9月1日至1989年9月1日间在圣路易斯巴恩斯医院发生念珠菌血症的所有患者的人口统计资料、危险因素、治疗和结果进行了回顾。发现106名念珠菌病患者，占内科和外科出院总数的0.5%，占病人出院总数的0.33%。与1976-1979年间相比，我们医院的念珠菌血症发病率增加了20倍。分离菌株以白色念珠菌最多(63%)，其次为热带念珠菌(17%)、光滑念珠菌(13%)、近缘念珠菌(6.5%)、克鲁斯假丝酵母菌(0.9%)。总死亡率为57%，60例死亡中有14例(23%)发生在发现念珠菌血症后48小时内。死亡率与APACHE II评分较高(死亡者为25分，存活者为16分；P=.0001)、存在快速致命性基础疾病(P=.0009)以及血培养持续阳性(P=.02)有关。在持续白念珠菌血症的病例中，分离出非白色念珠菌也与死亡率增加相关(8例中有8例，21例中10例；P=.005)。30名念珠菌病患者(28%)没有接受任何抗真菌治疗，其中19名(63%)死亡。11名未经治疗的患者(37%)存活下来，没有后遗症。我们机构的念珠菌血症发病率明显增加，这与较高的总死亡率有关。持久的念珠菌感染
Demographic information, risk factors, therapy, and outcome for all patients who had candidemia at Barnes Hospital, St. Louis, between 1 September 1988 and 1 September 1989 were retrospectively reviewed. One hundred six candidemic patients were identified, representing 0.5% of all medical and surgical discharges and 0.33% of total patient discharges. These percentages represent a 20-fold increase in the incidence of candidemia at our hospital in comparison with that during 1976-1979. Candida albicans was the most frequently isolated species (63%), followed by Candida tropicalis (17%), Candida glabrata (13%), Candida parapsilosis (6.5%), and Candida krusei (0.9%). Overall mortality was 57%, and 14 (23%) of 60 deaths occurred within 48 hours of the detection of candidemia. Mortality was associated with higher APACHE II scores (25 for nonsurvivors vs. 16 for survivors; P = .0001), the presence of a rapidly fatal underlying illness (P = .0009), and sustained positivity of blood cultures (P = .02). In cases of sustained candidemia, the isolation of non-albicans Candida species also correlated with increased mortality (8 of 8 vs. 10 of 21; P = .005). Thirty candidemic patients (28%) did not receive any antifungal therapy, and 19 (63%) of these untreated patients died. Eleven untreated patients (37%) survived without sequelae. There has been a marked increase in the incidence of candidemia in our institution that is associated with a high overall mortality. Candidemia lasting