Factors associated with the development of candidemia and candidemia-related death among liver transplant recipients.
Factors associated with the development of candidemia and candidemia-related death among liver transplant recipients.
复制标题
肝移植受者中与念珠菌血症发生和念珠菌血症相关死亡相关的因素。
DOI：
10.1097/00000658-199601000-00010
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发表时间：
1996
影响因子：
9
通讯作者：
Starzl,TE
中科院分区：
文献类型：
--
作者：
Nieto-Rodriguez,JA;Kusne,S;Mañez,R;Irish,W;Linden,P;Magnone,M;Wing,EJ;Fung,JJ;Starzl,TE
目的研究念珠菌血症和念珠菌相关死亡的相关因素，为临床治疗提供参考。背景资料侵袭性念珠菌病是肝移植术后最常见的严重真菌感染，具有较高的发病率和死亡率。虽然念珠菌血症并不总是发现在侵袭性念珠菌病，它已被认为是一个指标的侵袭性念珠菌病在免疫功能低下的patients.Methods一个时间匹配的病例对照研究26例念珠菌血症，这是定义为念珠菌分离至少一个血培养，和52例对照患者无念珠菌血症。两个对照组患者与每例患者的移植时间和随访时间相匹配。结果在1985年12月至1992年12月期间，念珠菌血症在1.4%的成人肝移植受者中位25天移植后（范围，2-1690天）。念珠菌血症患者的总体死亡率为81%，其中71%的死亡与念珠菌血症有关。采用条件Logistic回归分析确定与念珠菌血症相关的因素，包括1）念珠菌血症发生前2周内接受胰岛素治疗的高血糖（比值比[OR]，16.15; p= 0.002）和2）发生念珠菌血症前暴露于3种以上不同的静脉抗生素（OR，11.15; p= 0.005）。预测念珠菌血症相关死亡的变量是在念珠菌血症前1周内进行腹部手术（相对风险[RR]，7.25; p= 0.02），高白色血细胞计数（RR，1.10; p= 0.01），血小板计数降低（RR，0.99; p= 0.02），AST升高伴念珠菌血症结论肝移植受者高胰岛素血症和使用3种以上抗生素是发生念珠菌血症的相关因素。当腹部手术后不久发生念珠菌血症时，AST升高、白色血细胞计数升高或血小板计数降低的患者死亡率较高。
Objective The authors' objective was to identify factors associated with candidemia and candidemia-related death among adult liver transplant recipients.Summary Background Data Invasive candidiasis is the most common severe fungal infection occurring after liver transplantation and is associated with high morbidity and mortality rates. Although candidemia is not always found during invasive candidiasis, it has been considered as an indicator of invasive candidiasis in immunocompromised patients.Methods A time-matched case-control study of 26 patients with candidemia, which was defined as the isolation of Candida from at least one blood culture, and 52 control patients without candidemia was reported. Two control patients were matched with each case patient regarding time of transplantation and duration of follow-up.Results Between December 1985 and December 1992, candidemia developed in 1.4% of adult liver transplant recipients a median of 25 days after transplantation (range, 2-1690 days). The overall mortality rate among patients with candidemia was 81%, and 71% of these deaths were related to candidemia. Conditional logistic regression analysis was used to identify factors associated with candidemia, which were 1) hyperglycemia treated with insulin up to 2 weeks before candidemia (odds ratio [OR], 16.15; p= 0.002), and 2) exposure to more than three different intravenous antibiotics before development of candidemia (OR, 11.15; p= 0.005). The variables predictive of death related to candidemia were abdominal surgery performed up to 1 week before candidemia (relative risk [RR], 7.25; p= 0.02), high white blood cell count (RR, 1.10; p= 0.01), lower platelet count (RR, 0.99; p= 0.02), and elevated AST with candidemia (RR, 1.001; p= 0.01).Conclusions Hyperglycemia that requires insulin and exposure to more than three antibiotics are the factors associated with the development of candidemia in liver transplant recipients. When candidemia develops shortly after abdominal surgery and in patients with elevated AST, high white blood cell count, or low platelet count, it is associated with a high mortality rate.