Risk factors for albicans and non-albicans candidemia in the intensive care unit
Risk factors for albicans and non-albicans candidemia in the intensive care unit
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DOI：
10.1097/ccm.0b013e31816fc4cd
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发表时间：
2008-07-01
影响因子：
8.8
通讯作者：
Hadley, Susan
中科院分区：
文献类型：
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作者：
Chow, Jennifer K.;Golan, Yoav;Hadley, Susan
Objective.确定危重患者中非白色念珠菌（C-NA）和白色念珠菌（CA）血流感染（BSI）的危险因素。病例对照研究。设置。两所大学医院的成人内科和外科重症监护室（ICU）。患者：1995-2005年C-NA和CA BSI的连续患者组成了两个病例组。对照组为无念珠菌血症的患者，以5：1的比例随机选择，并按研究医院、ICU类型（内科与外科）和ICU入院日期在3个月内进行匹配。干预措施：收集的数据包括人口统计学、合并症、抗生素和抗真菌药暴露以及ICU因素，如全胃肠外营养（TPN）、血液制品输注、侵入性操作、中心静脉导管、血液透析和机械通气。我们建立了多变量逻辑回归模型，与对照组相比，确定了C-NA或CA BSI的风险因素。根据风险时间调整变量。测量和主要结果。有67例C-NA BSI患者，79例CA BSI患者和780例对照。在多变量模型中，与对照组相比，与C-NA风险增加相关的因素包括重症监护室前的大手术[比值比;（95%置信区间）] [2.12;（1.14-3.97）]、胃肠道手术[2.24;（1.49-3.38）]，肠菌血症P.43;（1.39-8.48）]，透析天数[6.20;（2.67-14.4）]、TPN持续时间[2.87;（1.40-5.90）]和平均红细胞输注次数[2.72;（1.33-5.58）]。与对照组相比，与CA BSI风险增加相关的因素非常相似，包括重症监护室手术[1.26;（1.14-3.97）]，肠菌血症[3.45;（1.38-8.63）），透析天数[3.84;（1.75- 8.40）]、TPN持续时间[11.0;（5.52-21.7）]和平均红细胞输注次数[1.97;（0.98-3.99）]。白色念珠菌和C.白色念珠菌BSI，然而，我们不能单独根据临床特征区分这两组。
Objective. To determine risk factors for bloodstream infections (BSI) with Candida non-albicans (C-NA) species and Candida albicans (CA) among critically ill patients.Design. Case-control study.Setting. Adult medical and surgical intensive care units (ICUs) at two university hospitals.Patients: Consecutive patients with C-NA and CA BSIs from 1995-2005 formed the two case groups. Controls were patients without candidemia who were randomly selected in a ratio of 5:1 and matched by study hospital, ICU type (medical vs. surgical) and by ICU admission date within a 3-month period.Interventions: Data collected included demographics, comorbidities, exposure to antibiotics and antifungals, and ICU factors such as total parenteral nutrition (TPN), blood product transfusions, invasive procedures, central venous catheters, hemodialysis, and mechanical ventilation. We built multivariable logistic regression models, which identified risk factors for C-NA or CA BSIs compared with controls. Variables were adjusted for time-at-risk.Measurements and Main Results. There were 67 patients with C-NA BSIs, 79 patients with CA BSIs, and 780 controls. In multivariable models, factors associated with an increased risk of C-NA compared with controls included major pre-ICU operations [odds ratio; (95% confidence interval)] [2.12; (1.14-3.97)], gastrointestinal procedures [2.24; (1.49-3.38)], enteric bacteremia P.43; (1.39-8.48)], number of hemodialysis days [6.20; (2.67-14.4)], TPN duration [2.87; (1.40-5.90)], and mean number of red blood cell transfusions [2.72; (1.33-5.58)]. Factors associated with an increased risk of CA BSIs compared to controls were very similar and included major ICU operations [1.26; (1.14-3.97)], enteric bacteremia [3.45; (1.38-8.63)), number of hemodialysis days [3.84; (1.75- 8.40)], TPN duration [11.0; (5.52-21.7)] and mean number of red blood cell transfusions [1.97; (0.98-3.99)].Conclusions: We found multiple common risk factors for both non-C. albicans and C. albicans BSIs, however we could not differentiate between these two groups based on clinical characteristics alone.