Evaluation of the Treatment of Candiduria at an Academic Medical Center
Evaluation of the Treatment of Candiduria at an Academic Medical Center
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学术医疗中心念珠菌尿症治疗的评估
DOI：
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发表时间：
2016
影响因子：
4.2
通讯作者：
B. Erstad
中科院分区：
文献类型：
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作者：
John J. Radosevich;D. Nix;B. Erstad
评价重症监护病房（ICU）和内科病房（MW）患者念珠菌尿的流行病学、管理和结局。这是一项在三级医疗学术医学中心进行的回顾性队列研究。纳入2010年7月至2011年6月期间住院至少5天且尿培养生长念珠菌属的18 - 75岁成人患者。对病历进行回顾性审查。实验室数据，泌尿系统症状，泌尿系统和侵袭性念珠菌病的危险因素，治疗和患者的结果进行了收集和评估。67名ICU患者和65名MW患者符合入选标准。ICU患者更可能有侵袭性念珠菌病和念珠菌尿的危险因素。白色念珠菌和光滑念珠菌是最常见的尿液分离株。尽管快速更换或取出了尿引流装置，且缺乏患者报告的症状，但通常仍开始抗真菌治疗。氟康唑是最常用的抗真菌药物，其次是米卡芬净。ICU组和MW组的住院时间无显著差异（P = 0.0628）。ICU患者的全因死亡率高于MW患者（22.4% vs.3.1%，P = 0.0012）。ICU和MW患者在发生念珠菌尿的危险因素和结局方面存在差异。在该患者队列中，抗真菌药（包括氟康唑和米卡芬净）经常使用不当（即，无症状患者）。努力提高医疗保健提供者对管理念珠菌尿症的当代建议的认识，对于改善患者护理和抗真菌药物的使用是必要的。
To evaluate the epidemiology, management, and outcomes associated with candiduria in intensive care unit (ICU) and medical ward (MW) patients. This was a retrospective cohort study conducted in a tertiary care academic medical center. Adult patients aged between 18 and 75 years who were admitted for at least 5 days with a urinary culture that grew a Candida species between July 2010 and June 2011 were included. Medical records were retrospectively reviewed. Laboratory data, urinary symptoms, risk factors for urinary and invasive candidiasis, treatment, and patient outcomes were collected and evaluated. Sixty-seven ICU and 65 MW patients met the inclusion criteria. ICU patients were more likely to have risk factors for invasive candidiasis and candiduria. Candida albicans and Candida glabrata were the most frequently identified urinary isolates. Antifungal therapy was commonly initiated despite rapid replacement or removal of urinary drainage devices and a lack of patient reported symptoms. Fluconazole was the most commonly used antifungal agent, followed by micafungin. Hospital length of stay did not vary significantly between the ICU and MW groups (P = 0.0628). All-cause mortality was higher in the ICU patients compared with that of the MW patients (22.4% vs. 3.1%, P = 0.0012). Differences exist between ICU and MW patients that develop candiduria with respect to risk factors, and outcomes. Antifungals, including fluconazole and micafungin, were often used inappropriately (ie, asymptomatic patients) in this patient cohort. Efforts to improve healthcare provider awareness of the contemporary recommendations to manage candiduria are necessary to improve patient care and antifungal use.