Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: A multi-institutional study
Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: A multi-institutional study
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DOI：
10.1086/504810
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发表时间：
2006-07-01
影响因子：
11.8
通讯作者：
Bearden, David T.
中科院分区：
文献类型：
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作者：
Garey, Kevin W.;Rege, Milind;Bearden, David T.
背景。抗菌药物治疗不足是医院死亡率的独立决定因素，真菌血液感染是初始治疗不当率最高的感染类型之一。由于延迟治疗具有降低高死亡率的巨大潜力，我们试图评估多个研究地点延迟治疗的影响。我们分析的目的是确定延迟抗真菌治疗的频率和持续时间，并评估治疗延迟与死亡率之间的关系。我们对来自4个医疗中心的服用氟康唑的念珠菌病患者进行了回顾性队列研究。开始氟康唑治疗的时间由首次酵母阳性血液样本的培养日期减去开始氟康唑治疗的日期计算。共发现230例患者（51%为男性，平均年龄+/-标准差，年）；其中192人之前未接受过氟康唑治疗。患者最常见的是非手术住院（162例[70%]），中心静脉导管（193例[84%]），糖尿病（68例[30%]）或癌症（54例[24%]）。引起感染的念珠菌种类包括白色念珠菌（129例[56%]）、光秃念珠菌（38例[16%]）、假丝酵母菌（25例[11%]）、热带念珠菌（15例[7%]）。开始抗真菌治疗的天数分别为0（92例[40%]）、1（38例[17%]）、2（33例[14%]）或>= 3（29例[12%]）。死亡率最低的是第0天开始治疗的患者（14例[15%]），其次是第1天开始治疗的患者（9例[24%]）、第2天开始治疗的患者（12例[37%]）或第3天开始治疗的患者（12例[41%]）（趋势）。多因素logistic回归的Pp值为0009，用于计算死亡率的独立预测因子，包括氟康唑起始时间增加（优势比为1.42）和急性生理和慢性健康评估II评分（增加1分，优势比P < 0.05）。比,1.13;)。P < 0.05)。住院念珠菌患者延迟开始氟康唑治疗显著影响死亡率。需要新的方法来避免延误适当的抗真菌治疗，例如快速诊断测试或识别独特的危险因素。
Background. Inadequate antimicrobial treatment is an independent determinant of hospital mortality, and fungal bloodstream infections are among the types of infection with the highest rates of inappropriate initial treatment. Because of significant potential for reducing high mortality rates, we sought to assess the impact of delayed treatment across multiple study sites. The goals our analyses were to establish the frequency and duration of delayed antifungal treatment and to evaluate the relationship between treatment delay and mortality.Methods. We conducted a retrospective cohort study of patients with candidemia from 4 medical centers who were prescribed fluconazole. Time to initiation of fluconazole therapy was calculated by subtracting the date on which fluconazole therapy was initiated from the culture date of the first blood sample positive for yeast.Results. A total of 230 patients ( 51% male; mean age +/- standard deviation, years) were identified; 56 +/- 17 192 of these had not been given prior treatment with fluconazole. Patients most commonly had nonsurgical hospital admission ( 162 patients [ 70%]) with a central line catheter ( 193 [ 84%]), diabetes ( 68 [ 30%]), or cancer ( 54 [ 24%]). Candida species causing infection included Candida albicans ( 129 patients [ 56%]), Candida glabrata ( 38 [ 16%]), Candida parapsilosis ( 25 [ 11%]), or Candida tropicalis ( 15 [ 7%]). The number of days to the initiation of antifungal treatment was 0 ( 92 patients [ 40%]), 1 ( 38 [ 17%]), 2 ( 33 [ 14%]) or >= 3 ( 29 [ 12%]). Mortality rates were lowest for patients who began therapy on day 0 ( 14 patients [ 15%]) followed by patients who began on day 1 ( 9 [ 24%]), day 2 ( 12 [ 37%]), or day >= 3 ( 12 [ 41%]) ( for trend). Multivariate logistic regression was Pp. 0009 used to calculate independent predictors of mortality, which include increased time until fluconazole initiation ( odds ratio, 1.42;) and Acute Physiology and Chronic Health Evaluation II score ( 1-point increments; odds P < .05). ratio, 1.13;). P < .05).Conclusion. A delay in the initiation of fluconazole therapy in hospitalized patients with candidemia significantly impacted mortality. New methods to avoid delays in appropriate antifungal therapy, such as rapid diagnostic tests or identification of unique risk factors, are needed.