Epidemiology and risk factors for nosocomial Non-Candida albicans candidemia in adult patients at a tertiary care hospital in North China
Epidemiology and risk factors for nosocomial Non-Candida albicans candidemia in adult patients at a tertiary care hospital in North China
复制标题
DOI：
10.1093/mmy/myv060
复制
发表时间：
2015-09-01
期刊：
影响因子：
2.9
通讯作者：
Su, Jianrong
中科院分区：
文献类型：
--
作者：
Ding, Xiurong;Yan, Donghui;Su, Jianrong
院内念珠菌病延长了住院时间，增加了医疗费用，并与高死亡率有关。帮助选择初始治疗的流行病学数据可能有助于改善预后。本研究旨在调查白色念珠菌和非白色念珠菌（NAC）引起的院内念珠菌感染的流行病学，并确定其危险因素。回顾性分析2008年1月至2012年12月在北京友谊医院治疗的院内念珠菌病例。所有念珠菌病例均采用先前公布的标准确定。106例患者中，53.8%存在NAC引起的院内念珠菌血症。白色念珠菌是最常见的病原菌，占46.2%，其次为光秃念珠菌（25.5%）、热带念珠菌（15.1%）、副枯枝念珠菌（10.4%）和克鲁塞念珠菌（0.9%）。通过多因素logistic回归比较院内白色念珠菌与NAC念珠菌感染，结果显示与院内NAC念珠菌感染独立相关的因素包括暴露于唑类药物（优势比[OR]: 3.359； 95%可信区间[CI]: 1.136 ~ 10.154; P = 0.031）和人工手术植入物（OR: 37.519; 95% CI: 2.5 ~ 562.998; P = 0.009）。院内感染白色念珠菌的一个重要危险因素是癌症手术（OR: 0.075; 95% CI: 0.013-0.437; P = 0.004）。在选择治疗成人患者的初始抗真菌方案时，应考虑由白色念珠菌和NAC引起的院内念珠菌感染的危险因素的临床和流行病学差异。这应在获得物种鉴定和/或抗真菌敏感性结果之前进行。
Nosocomial candidemia extends the length of hospital stay, increases the costs of medical care, and is associated with a high mortality rate. Epidemiological data that assist in the choice of initial therapy may help to improve the prognosis. The present study was undertaken to investigate the epidemiology of nosocomial candidemia and identify risk factors for nosocomial candidemia caused by C. albicans and non-albicans Candida species (NAC). A retrospective chart review was undertaken to analyze cases of nosocomial candidemia treated at the Beijing Friendship Hospital between January 2008 and December 2012. All cases of candidemia were identified using the previously published criteria. Among 106 patients analyzed, 53.8% had nosocomial candidemia caused by NAC. Candida albicans was the most common causative agent, accounting for 46.2% of all cases, followed by C. glabrata (25.5%), C. tropicalis (15.1%), C. parapsilosis (10.4%) and C. Krusei (0.9%). Comparison of nosocomial C. albicans and NAC candidemia by multivariate logistic regression showed that factors independently associated with nosocomial NAC candidemia included exposure to azole agents (odds ratio [OR]: 3.359; 95% confidence interval [CI]: 1.136-10.154; P = .031) and artificial surgical implants (OR: 37.519; 95% CI: 2.5-562.998; P = .009). A significant risk factor for nosocomial C. albicans candidemia was cancer surgery (OR: 0.075; 95% CI: 0.013-0.437; P = .004). Clinical and epidemiological differences in the risk factors between nosocomial candidemia caused by C. albicans and NAC should be considered when selecting an initial antifungal regimen for the treatment of adult patients. This should be undertaken before the availability of species identification and/or antifungal susceptibility results.