Incidence, characteristics and outcome of ICU-acquired candidemia in India
Incidence, characteristics and outcome of ICU-acquired candidemia in India
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DOI：
10.1007/s00134-014-3603-2
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发表时间：
2015-02-01
影响因子：
38.9
通讯作者：
Mendiratta, Deepak
中科院分区：
文献类型：
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作者：
Chakrabarti, Arunaloke;Sood, Prashant;Mendiratta, Deepak
目的：对印度重症监护病房（ICU）获得性念珠菌血症进行系统流行病学研究。方法：在27个印度ICU进行了一项前瞻性、全国性、多中心、观察性研究。在2011年4月至2012年9月期间入组了在ICU入院后获得念珠菌血症的并发症患者。记录这些患者的临床和实验室变量。本研究是对成人患者特定数据的分析。结果：在1,400例ICU获得性念珠菌血症病例中（总发病率为6.51例/1,000例ICU入院），65.2%为成人。尽管该研究证实了已知的念珠菌血症风险因素，但在进入ICU后早期（中位数8天;四分位数间距4-15天）发生了感染，甚至感染了入院时APACHE II评分较低的患者（中位数17.0;平均值+/- SD 17.2 +/- 5.9;四分位数间距14-20）。该研究的重要发现是引起念珠菌血症的广泛的病原体（31种念珠菌）和热带念珠菌的高分离率（41.6%）。唑类和多药耐药率分别为11.8%和1.9%。公共部门医院报告了相对耐药的C。auris（8.2 vs.3.9%; p = 0.008）和C.皱纹（5.6 vs. 1.5%; p = 0.001）。念珠菌血症患者的30天粗死亡率和归因死亡率分别为44.7%和19.6%。Logistic回归分析显示，死亡率的重要独立预测因素包括：入住公立医院、入院时APACHE II评分、基础肾衰竭、中心静脉导管插入术和类固醇治疗。结论：该研究强调了印度ICU中念珠菌血症的高负担，ICU入院后的早期发病，尽管入院时的生理学评分不太严重，但风险较高，以及引起疾病的多种药物，其中以C为主。热带植物
Purpose: A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India. Method: A prospective, nationwide, multicentric, observational study was conducted at 27 Indian ICUs. Consecutive patients who acquired candidemia after ICU admission were enrolled during April 2011 through September 2012. Clinical and laboratory variables of these patients were recorded. The present study is an analysis of data specific for adult patients. Results: Among 1,400 ICU-acquired candidemia cases (overall incidence of 6.51 cases/1,000 ICU admission), 65.2 % were adult. Though the study confirmed the already known risk factors for candidemia, the acquisition occurred early after admission to ICU (median 8 days; interquartile range 4-15 days), even infecting patients with lower APACHE II score at admission (median 17.0; mean +/- SD 17.2 +/- 5.9; interquartile range 14-20). The important finding of the study was the vast spectrum of agents (31 Candida species) causing candidemia and a high rate of isolation of Candida tropicalis (41.6 %). Azole and multidrug resistance were seen in 11.8 and 1.9 % of isolates. Public sector hospitals reported a significantly higher presence of the relatively resistant C. auris (8.2 vs. 3.9 %; p = 0.008) and C. rugosa (5.6 vs. 1.5 %; p = 0.001). The 30-day crude and attributable mortality rates of candidemia patients were 44.7 and 19.6 %, respectively. Logistic regression analysis revealed significant independent predictors of mortality including admission to public sector hospital, APACHE II score at admission, underlying renal failure, central venous catheterization and steroid therapy. Conclusion: The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of C. tropicalis.