Evaluation of the guidelines for infection control and prevention, which was made for national university hospitals in Japan

为日本国立大学医院制定的感染控制和预防指南的评估

• 批准号: 14572182
• 负责人: IINUMA Yoshitsugu
• 金额: $ 2.18万
• 依托单位: KYOTO UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2002
• 资助国家: 日本
• 起止时间: 2002 至 2003
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-14572182/
• 关键词: Deep mycosis; Candida bacteremia; Fluconazole resistance; Hematologic malignancy; Appropriate use of anti-fungal drugs; Central venous catheter; 真菌血症; 抗真菌薬感受性検査; 新規抗真菌薬; βグルカン; 悪性腫瘍; clinical break point

In a 1 year national-wide surveillance program, 535 Candida blood isolates were collected. The overall species distribution was: 41% Candida albicans, 23% Candida parapsilosis, 18% Candida grabrata, 12% Candida tropicalis and 2% Candida krusei. Percentage of fluconazole resistance were 7.8% for all isolates, while, newer agents, voriconazole and micafangin, were both more active than fluconazole for almost all species. Univariate analysis of the demographic and clinical factors associated with fluconazole resistance revealed that age, hematologic malignancy, neutropenia, and immunosuppression were of statistical significance. A multiple logistic regression model showed that only hematologic malignancy as the underlying disease (odds ratio, 6.6; 95% confidence interval, 1.6-26.9; P=0.009) was independently associated with resistance. In 242 cases in which data regarding management and prognosis were available, the 30-day survival rate was 68.4%. In the univariate analysis of factors predicting survival, a significant association was found for Candida species, age of the patient, neutropenia, recent abdominal surgery, removal of the central venous catheter, and use of appropriate antifungal therapy. In the multivariate analysis, removal of the central venous catheter (odds ratio, 6.0; 95% confidence interval, 2.2-16.1; P<0.001) and the use of appropriate therapy (odds ratio, 2.1; 95% confidence interval, 1.1-4.1; P=0.03) were independent factors significantly associated with survival after the diagnosis of Candida bloodstream infection. This work is the first nationwide, large-scale surveillance study conducted in Japan to obtain microbiological and clinical data of Candida bloodstream infection. The data obtained in this study would be indispensable for making clinical guideline for Candida bloodstream infection in Japan.

在一项为期 1 年的全国性监测计划中，收集了 535 份念珠菌血液分离株。总体物种分布为：41%白色念珠菌、23%近平滑念珠菌、18%格拉布拉塔念珠菌、12%热带念珠菌和2%克柔念珠菌。所有分离株的氟康唑耐药性百分比均为 7.8%，而对于几乎所有物种，较新的药物伏立康唑和米卡芳净都比氟康唑更有效。对与氟康唑耐药相关的人口和临床因素的单变量分析显示，年龄、血液恶性肿瘤、中性粒细胞减少和免疫抑制具有统计学意义。多重逻辑回归模型显示，只有血液系统恶性肿瘤作为基础疾病（比值比，6.6；95% 置信区间，1.6-26.9；P=0.009）与耐药性独立相关。在 242 例可获得治疗和预后数据的病例中，30 天生存率为 68.4%。在预测生存因素的单变量分析中，发现念珠菌种类、患者年龄、中性粒细胞减少、近期腹部手术、中心静脉导管拔除以及使用适当的抗真菌治疗之间存在显着关联。在多变量分析中，拔除中心静脉导管（比值比，6.0；95%置信区间，2.2-16.1；P<0.001）和使用适当的治疗（比值比，2.1；95%置信区间，1.1-4.1；P=0.03）是与念珠菌血流感染诊断后生存显着相关的独立因素。这项工作是日本首次进行的全国性大规模监测研究，以获得念珠菌血流感染的微生物学和临床数据。这项研究获得的数据对于制定日本念珠菌血流感染的临床指南是必不可少的。

项目成果

Takakura S, Iinuma Y, et al.: "Clinical factors associated with fluconazole resistance and short-term prognosis of patients with Candida bloodstream infection"Eur J Clin Microbiol Infect Dis. in press.

Takakura S、Iinuma Y 等：“与氟康唑耐药相关的临床因素和念珠菌血流感染患者的短期预后”Eur J Clin Microbiol Infect Dis。

Takakura S, Fujihara N, Saito T, Kudo T, Iinuma Y, Ichiyama S. Nakashima K, Baba H, Hasegawa Y, Shimokata K.: "National surveillance of species distribution in blood isolates of Candida species in Japan and their susceptibility to six antifungal agents in

Takakura S、Fujihara N、Saito T、Kudo T、Iinuma Y、Ichiyama S. Nakashima K、Baba H、Hasekawa Y、Shimokata K.：“日本念珠菌血液分离株的物种分布及其对六种细菌的易感性的国家监测

Saito T, Senda K, Takakura S, Fujihara N, Kudo T, Iinunia Y, Kiuchi T, Tanimoto M, Ichiyama S.: "Biliary bacteria in living related liver transplant recipients: Microbiology and rapid detection system using flow cytometry"Clin Chem Lab Med. 41. 159-163 (2

Saito T、Senda K、Takakura S、Fujihara N、Kudo T、Iinunia Y、Kiuchi T、Tanimoto M、Ichiyama S.：“活体相关肝移植受者中的胆汁细菌：使用流式细胞术的微生物学和快速检测系统”临床化学实验室

Saito T, Iinuma Y, et al.: "Detection of bacteria and fungi in BacT/Alert standard blood-culture bottles"J Infect Chemother. 91. 227-232 (2003)

Saito T、Iinuma Y 等人：“BacT/Alert 标准血培养瓶中细菌和真菌的检测”J Infect Chemother。

Takakura S, Fujihara N, Saito T, Kudo T, Iinuma Y, Ichiyama S: "Clinical factors associated with fluconazole resistance and short-term prognosis of patients with Candida bloodstream infection"Eur J Glin Microbiol Infect Dis. 23. 380-388 (2004)

Takakura S、Fujihara N、Saito T、Kudo T、Iinuma Y、Ichiyama S：“与氟康唑耐药性相关的临床因素和念珠菌血流感染患者的短期预后”Eur J Glin Microbiol Infect Dis。