Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia
Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia
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DOI：
10.1128/jcm.00179-11
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发表时间：
2011-09-01
影响因子：
9.4
通讯作者：
Johansen, Helle Krogh
中科院分区：
文献类型：
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作者：
Arendrup, Maiken Cavling;Sulim, Sofia;Johansen, Helle Krogh
这项研究调查了丹麦真菌血症患者的微生物学、临床和管理问题和结果。在六个中心收集了分离株和临床信息。共纳入334株分离株、316例病例和305例患者，相当于全国病例的三分之二。血培养阳性因系统、种类和程序不同而不同。因此，BACT/ALERT系统报告的伴发菌血症病例比BACTEC系统报告的病例少(9%[11/124例]比28%[53/192例]；P<；0.0001)，光滑念珠菌培养或通过动脉途径提取的培养需要更长的培养时间。菌种分布因年龄、既往抗真菌治疗情况不同而不同(接受过抗真菌治疗的患者发生光滑葡萄球菌、酿酒酵母或克鲁斯葡萄球菌的发生率为57%，未接受抗真菌治疗的患者为28%；P=0.007)，以及临床专业(血液科病房发生光滑葡萄球菌或克鲁斯葡萄球菌的发生率为61%，其他病房为27%；P=0.002)。在11/100的病例中，定植样本不能预测入侵物种。56%的患者接受过手术，51%的患者是重症监护病房(ICU)患者，33%的患者患有恶性疾病。死亡率随年龄(P=0.009)、种类(克鲁斯念珠菌36%、近缘念珠菌25%、其他念珠菌14%)、基础疾病的严重程度(ICU患者为47%，其他患者为24%；P=0.0001)以及最初治疗的选择而不同(接受卡泊芬净和氟康唑的患者分别为12%和48%；P=0.023)而不同。在15%的病例中，最初的抗真菌药物在物种鉴定时被认为是次优的，如果遵循当前的指南，这一比例将达到6.5%。很大比例的丹麦真菌血症患者病情严重，接受了不太理想的初始抗真菌治疗。优化诊断和治疗是可能的。
This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included, corresponding to 2/3 of the national episodes. Blood culture positivity varied by system, species, and procedure. Thus, cases with concomitant bacteremia were reported less commonly by BacT/Alert than by the Bactec system (9% [11/124 cases] versus 28% [53/192 cases]; P < 0.0001), and cultures with Candida glabrata or those drawn via arterial lines needed longer incubation. Species distribution varied by age, prior antifungal treatment (57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C. glabrata or C. krusei in hematology wards versus 27% occurrence in other wards; P = 0.002). Colonization samples were not predictive for the invasive species in 11/100 cases. Fifty-six percent of the patients had undergone surgery, 51% were intensive care unit (ICU) patients, and 33% had malignant disease. Mortality increased by age (P = 0.009) and varied by species (36% for C. krusei, 25% for C. parapsilosis, and 14% for other Candida species), severity of underlying disease (47% for ICU patients versus 24% for others; P = 0.0001), and choice but not timing of initial therapy (12% versus 48% for patients with C. glabrata infection receiving caspofungin versus fluconazole; P = 0.023). The initial antifungal agent was deemed suboptimal upon species identification in 15% of the cases, which would have been 6.5% if current guidelines had been followed. A large proportion of Danish fungemia patients were severely ill and received suboptimal initial antifungal treatment. Optimization of diagnosis and therapy is possible.