Candidemia in major burn patients and its possible risk factors: A 6-year period retrospective study at a burn ICU
Candidemia in major burn patients and its possible risk factors: A 6-year period retrospective study at a burn ICU
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严重烧伤患者的念珠菌血症及其可能的危险因素：烧伤 ICU 的 6 年回顾性研究
DOI：
10.1016/j.burns.2019.01.005
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发表时间：
2019-08-01
期刊：
影响因子：
2.7
通讯作者：
Luo, Gaoxing
中科院分区：
文献类型：
--
作者：
Zhou, Junyi;Tan, Jianglin;Luo, Gaoxing
目的：本研究的目的是评估典型烧伤ICU中念珠菌血症的流行病学和临床特征，并确定与严重烧伤患者中念珠菌血症相关的危险因素。方法：本回顾性观察性研究于2012年至2017年在中国重庆西南医院烧伤科进行。结果：该研究包括410名严重烧伤患者（>= 40%总体表面积），其中39名（9.51%）被诊断为念珠菌血症。念珠菌血症的年发病率为6.06%~ 17.54%，在6年间呈逐渐上升趋势。近平滑假丝酵母菌为主要致病菌，占28.21%。念珠菌的总体耐药率。对氟康唑的耐药率为35.89%。烧伤后第2周（30.77%）和第3周（23.08%）为念珠菌血症的高发期，血管内导管是最常见的念珠菌感染源（31.58%）。念珠菌血症的粗死亡率为23.08%，归因于念珠菌血症的死亡率为14.99%。吸入性损伤、替代治疗肾功能不全、严重胃肠道并发症、T淋巴细胞减少及念珠菌定植等是严重烧伤患者念珠菌血症的危险因素。病原学和药物敏感性的变化可能对烧伤ICU念珠菌血症的管理提出新的挑战。(C)2019 Elsevier Ltd和ISBI。All rights reserved.
Objective: The aims of this study were to evaluate the epidemiological and clinical characteristics of candidemia in a typical burn ICU, and to determine the risk factors associated with candidemia among major burn patients.Method: This retrospective observational study of candidemia from 2012 to 2017 in a burn ICU was conducted in the Department of Burn, Southwest hospital, Chongqing, China.Results: The study included 410 major burn patients (>= 40% total body surface area), 39 (9.51%) of which were diagnosed with candidemia. The annual incidences of candidemia varied from 6.06% to 17.54%, and increased gradually in the 6 years. Candida parapsilosis was the dominant pathogen (28.21% strains). The overall resistance rate of Candida spp. to fluconazole was 35.89%. Candidemia cases most frequently occurred in the 2nd (30.77%) and 3rd (23.08%) weeks after burn, and intravascular catheters were the most common sources of bloodstream Candida infections (31.58%). The crude mortality of candidemia was 23.08%, and the mortality attributable to candidemia was 14.99%. Risk factors of candidemia included inhalation injury, renal dysfunction with replacement therapy, severe gastrointestinal complications, T-cell lymphopenia and prior Candida colonization.Conclusion: Candidemia has a high incidence and mortality in major burn patients. The changes in etiology and drug sensitivity may make new challenges for the management of candidemia in burn ICUs. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.