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

在为期1年的全国监测计划中，收集了535株念珠菌血分离株。总体菌种分布为：白色念珠菌占41%，假丝酵母菌占23%，抓性念珠菌占18%，热带念珠菌占12%，克氏念珠菌占2%。所有菌株对氟康唑的耐药率为7.8%，而伏立康唑和米加芬对几乎所有菌株的耐药率均高于氟康唑。单因素分析与氟康唑耐药相关的人口学和临床因素显示，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。多元logistic回归模型显示，只有血液恶性肿瘤作为基础疾病（优势比为6.6；95%可信区间为1.6-26.9；P=0.009）与耐药独立相关。在242例有治疗和预后资料的病例中，30天生存率为68.4%。在预测生存的单因素分析中，念珠菌种类、患者年龄、中性粒细胞减少症、近期腹部手术、中心静脉导管切除和使用适当的抗真菌治疗与生存率有显著相关性。在多因素分析中，中心静脉导管的拔除（优势比6.0,95%可信区间2.2-16.1，P<0.001）和适当治疗的使用（优势比2.1,95%可信区间1.1-4.1，P=0.03）是与念珠菌血流感染诊断后存活显著相关的独立因素。这项工作是在日本进行的第一个全国性的大规模监测研究，以获得念珠菌血液感染的微生物学和临床数据。本研究获得的数据将为制定日本念珠菌血流感染的临床指南提供必要的依据。

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.