Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections
Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections
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DOI：
10.1093/jac/dks347
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发表时间：
2013-01-01
影响因子：
5.2
通讯作者：
Lepe-Jimenez, Jose A.
中科院分区：
文献类型：
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作者：
Garnacho-Montero, Jose;Diaz-Martin, Ana;Lepe-Jimenez, Jose A.
我们着手确定成人念珠菌患者的预后因素。血流感染，评估导管拔除对院内死亡率的影响和抗真菌治疗的充分性。以及在念珠菌血症时放置中心静脉导管。收集的数据包括人口统计学资料、基础疾病、疾病严重程度、临床表现、导管撤回和经验治疗的充分性。我们纳入了188名患者（死亡率36.7）。早期充分抗真菌治疗的患者死亡率为34.9（23/66），早期充分抗真菌治疗并在最初48 h内拔管的患者死亡率为18.9（7/37）。阿帕奇（急性生理学和慢性健康评估）念珠菌血症当天的II评分[校正风险比（aHR）1.12; 95 CI 1.061.17; P0.001]与死亡相关，而早期适当治疗（aHR 0.4; 95 CI 0.230.83; P0.012）和拔管（aHR 0.34; 95 CI 0.160.70; P0.03）为保护因素。在原发性念珠菌血症中，接受充分治疗的患者在最初48小时内死亡率为28（14/50），接受两种干预的患者死亡率降至17.7（6/34）。拔除导管是一个保护因素，前48小时内充分的抗真菌治疗显示出对死亡的强烈保护趋势（aHR 0.46; 95 CI 0.191.08; P0.07）。在继发性非导管相关性念珠菌血症中，只有早期适当的治疗是死亡率的保护因素，延迟拔管和给予适当的抗真菌治疗与念珠菌血症患者死亡率增加相关。导管管理不影响继发性非导管相关念珠菌血症的预后。
We set out to identify the prognostic factors in adult patients with Candida spp. bloodstream infection, assessing the impact on in-hospital mortality of catheter removal and adequacy of antifungal therapy.Patients with positive blood culture for Candida spp. and a central venous catheter in place at the time of candidaemia were included. Data collected included demographics, underlying diseases, severity of illness, clinical presentation, catheter withdrawal and adequacy of empirical therapy.We included 188 patients (mortality 36.7). The mortality rate was 34.9 (23/66) in patients with early adequate antifungal treatment and 18.9 (7/37) in patients with early adequate antifungal therapy and catheter withdrawal in the first 48 h. The APACHE (Acute Physiology and Chronic Health Evaluation) II score on the day of candidaemia [adjusted hazard ratio (aHR) 1.12; 95 CI 1.061.17; P0.001] was associated with death whereas early adequate therapy (aHR 0.4; 95 CI 0.230.83; P0.012) and catheter withdrawal (aHR 0.34; 95 CI 0.160.70; P0.03) were protective factors. In primary candidaemia, mortality was 28 (14/50) in patients with adequate therapy and decreased to 17.7 (6/34) in patients with both interventions in the first 48 h. Catheter removal was a protective factor and adequacy of antifungal therapy in the first 48 h showed a strong tendency to protection against death (aHR 0.46; 95 CI 0.191.08; P0.07). In secondary non-catheter-related candidaemia, only early adequate therapy was a protective factor for mortality.Delay in catheter withdrawal and in administration of adequate antifungal therapy was associated with increased mortality in candidaemic patients. Catheter management did not influence the prognosis of secondary non-catheter-related candidaemia.