A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality
A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality
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DOI：
10.1007/s00134-015-3866-2
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发表时间：
2015-09-01
影响因子：
38.9
通讯作者：
Tumbarello, Mario
中科院分区：
文献类型：
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作者：
Bassetti, Matteo;Righi, Elda;Tumbarello, Mario
关于腹内念珠菌病(IAC)患者的临床数据仍然缺乏。我们收集了来自意大利、西班牙、巴西和希腊的13家医院的数据，包括来自ICU、内科和外科病房的患者。共有481名患者参与了这项研究。在这些人中，27%在ICU住院。平均年龄为63岁，57%的患者为男性。IAC以继发性腹膜炎(41%)和腹壁脓肿(30%)为主，合并念珠菌感染68例(14%)，合并细菌感染331例(69%)。最常见的念珠菌是白色念珠菌(n=308株，%)和光滑念珠菌(n=76，16%)。抗真菌治疗包括棘球菌素类(%)、氮唑类(32%)和两性霉素B(4%)。40.5%的患者出现感染性休克。总的30天住院死亡率为27%，其中ICU的死亡率为38.9%。多因素Logistic回归分析显示年龄(OR1.05，95%CI1.03~1.07，P<；0.001)、APACHE II评分递增(OR1.05，95%CI1.01~1.08，P=0.028)、继发性腹膜炎(OR1.72，95%CI1.02~2.89，P=0.019)、感染性休克(OR3.29，95%CI1.88~5.86，P<；)；0.001)和缺乏足够的腹部来源控制(OR3.35，95%CI2.01-5.63，P<；0.001)。在感染性休克患者中，缺乏源头控制与60%以上的死亡率相关，即使给予适当的抗真菌治疗。IAC中记录的伴发念珠菌血症的百分比较低，死亡率较高。在出现感染性休克的患者中，源头控制是根本。
Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce.We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011-2013) including patients from ICU, medical, and surgical wards.A total of 481 patients were included in the study. Of these, 27 % were hospitalized in ICU. Mean age was 63 years and 57 % of patients were male. IAC mainly consisted of secondary peritonitis (41 %) and abdominal abscesses (30 %); 68 (14 %) cases were also candidemic and 331 (69 %) had concomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64 %) and C. glabrata (n = 76, 16 %). Antifungal treatment included echinocandins (64 %), azoles (32 %), and amphotericin B (4 %). Septic shock was documented in 40.5 % of patients. Overall 30-day hospital mortality was 27 % with 38.9 % mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95 % CI 1.03-1.07, P < 0.001), increments in 1-point APACHE II scores (OR 1.05, 95 % CI 1.01-1.08, P = 0.028), secondary peritonitis (OR 1.72, 95 % CI 1.02-2.89, P = 0.019), septic shock (OR 3.29, 95 % CI 1.88-5.86, P < 0.001), and absence of adequate abdominal source control (OR 3.35, 95 % CI 2.01-5.63, P < 0.001) were associated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60 % irrespective of administration of an adequate antifungal therapy.Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental.