A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality
A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality
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DOI：
10.1007/s00134-014-3310-z
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发表时间：
2014-06-01
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
念珠菌是世界范围内严重酵母菌感染的最常见原因，特别是在危重患者中。在这种情况下，念珠菌感染性休克的特点是死亡率高。这项多中心研究的目的是调查的结果在危重病人感染性休克由于念珠菌血症的决定因素，这是一项回顾性研究，感染性休克患者归因于念珠菌谁是治疗在3年的研究期间，在一个或多个参与教学医院在意大利和西班牙有资格入组。患者的特征，感染相关的变量，和治疗相关的功能进行了审查。采用多元逻辑回归分析确定与30天死亡率显著相关的危险因素。共有216例患者（平均年龄63.4 ± 18.5岁; 58.3%为男性）纳入研究。其中163人（75%）被送入重症监护室。总体30天死亡率为54%。在死亡者和存活者中，比较了急性生理学和慢性健康评估（APACHE）II评分、器官功能障碍和抗真菌治疗不足。从血培养阳性到开始适当的抗真菌治疗的时间，幸存者与非幸存者之间没有差异。多变量logistic回归分析发现，源控制不足、抗真菌治疗不足和APACHE II评分增加1分是与30天死亡率较高相关的独立变量。
Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia.This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality.A total of 216 patients (mean age 63.4 +/- A 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.