Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections.
Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections.
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DOI：
10.1111/j.1469-0691.2012.03906.x
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Sohn JW
中科院分区：
文献类型：
--
作者：
Kim SH;Yoon YK;Kim MJ;Sohn JW
据报道，混合念珠菌/细菌血流感染（BSI）发生在所有念珠菌血症发作的23%以上。然而，混合念珠菌/细菌性BSI的临床意义尚不清楚。我们对所有连续5年的念珠菌血症患者进行了回顾性病例对照研究，以确定混合念珠菌/细菌BSI（病例）与单一微生物念珠菌血症（对照）的风险因素和临床结局。126例念珠菌血症患者中有37例（29%）符合病例标准。凝固酶阴性葡萄球菌是病例中的优势菌（23%）。在多变量分析中，既往住院时间≥7周（比值比（OR），2.86; 95%置信区间（CI），1.09-7.53），既往抗生素治疗≥7天（OR，0.33; 95%CI，0.14-0.82）和感染性休克时的念珠菌血症（OR，2.60; 95%CI，1.14-5.93）与病例显著相关。在开始抗真菌治疗后3天内记录的念珠菌血症清除率较低（63% vs 84%; p = 0.035）。病例组（68%）和对照组（62%; p = 0.55）之间2周治疗失败率的差异不显著。两组患者6周时的粗死亡率和100天生存率无差异（分别为p = 0.56和p = 0.80）。混合念珠菌/细菌性BSI在抗真菌治疗的早期表现出较低的念珠菌血症清除率，尽管无论并发菌血症如何，治疗反应和生存率都相似。需要进一步研究种属特异性真菌-细菌相互作用的临床相关性。
Mixed Candida/bacterial bloodstream infections (BSIs) have been reported to occur in more than 23% of all episodes of candidaemia. However, the clinical implications of mixed Candida/bacterial BSIs are not well known. We performed a retrospective case-control study of all consecutive patients with candidaemia over a 5-year period to determine the risk factors for and clinical outcomes of mixed Candida/bacterial BSIs (cases) compared with monomicrobial candidaemia (controls). Thirty-seven (29%) out of 126 patients with candidaemia met the criteria for cases. Coagulase-negative staphylococci were the predominant bacteria (23%) in cases. In multivariate analysis, duration of previous hospital stay ≥7 weeks (odds ratio (OR), 2.86; 95% confidence interval (CI), 1.09–7.53), prior antibiotic therapy ≥7 days (OR, 0.33; 95% CI, 0.14–0.82) and septic shock at the time of candidaemia (OR, 2.60; 95% CI, 1.14–5.93) were significantly associated with cases. Documented clearance of candidaemia within 3 days after initiation of antifungal therapy was less frequent in cases (63% vs. 84%; p = 0.035). The difference in the rate of treatment failure at 2 weeks was not significant between cases (68%) and controls (62%; p = 0.55). The crude mortality at 6 weeks and survival through 100 days did not differ between the two patient groups (p = 0.56 and p = 0.80, respectively). Mixed Candida/bacterial BSIs showed a lower clearance rate of candidaemia during the early period of antifungal therapy, although the treatment response and survival rate were similar regardless of concurrent bacteraemia. Further studies on the clinical relevance of species-specific Candida-bacterial interactions are needed.
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影响因子：
3.1
作者：
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通讯作者：
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DOI：
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发表时间：
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