Candidemia in the elderly: What does it change?
Candidemia in the elderly: What does it change?
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DOI：
10.1371/journal.pone.0176576
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Manso E
中科院分区：
文献类型：
--
作者：
Barchiesi F;Orsetti E;Mazzanti S;Trave F;Salvi A;Nitti C;Manso E
念珠菌病是一种危及生命的真菌感染，可影响所有年龄段的患者。缺乏老年人念珠菌血症的特征。我们对2010年至2015年在我们中心诊断为念珠菌血症的成年人(≥18岁)进行了一项回顾性研究。比较了老年患者(≤65岁)和年轻患者(65岁)的人口学、合并症、临床和微生物学特征、抗真菌治疗和结果。在研究期间发现的302例念珠菌血症患者中，188例(62%)属于老年组。老年患者的合并症明显更常见，包括慢性肺部疾病、心血管疾病、糖尿病和慢性肾功能衰竭(p范围从0.0001到0.017)。在白念珠菌血症时，老年患者发生感染性休克的比例明显更高(p=0.040)。白色念珠菌占分离株的53%，患者年龄和念珠菌种类间差异无统计学意义。老年患者的30天死亡率(45%)显著高于年轻患者(28%)(p=0.003)。老年人死亡比例较高的相关因素包括：高龄(即：高龄)、住在重症监护室而不是其他病房、患有慢性肺部疾病、感染性休克、多器官衰竭、透析和感染光滑线虫(p值在0.0001至0.034之间)。在多变量分析中，感染性休克(HR 1.744[CI 95%1.049-2.898]，p=0.032)和多器官衰竭(HR 2.242[CI 95%1.070-4.698]，P=0.032)与较高的死亡风险独立相关。与没有接受任何治疗的年轻患者相比，老年患者30天存活的可能性显著降低(p=0.005)。老年人对氟康唑/白色念珠菌、氟康唑/光滑念珠菌、两性霉素B/光滑念珠菌、卡泊芬净/光滑念珠菌的MIC值有升高趋势。在我们的研究中，我们发现老年念珠菌血流感染患者具有高死亡率的特点。特别是，缺乏任何抗真菌治疗以及感染性休克的发生显著增加了总体死亡率。此外，我们还发现，特定药物/念珠菌联合用药的MIC有升高的趋势。
Candidemia is a life-threatening fungal infection and it can affect patients of all ages. Characterization of candidemia in the elderly is lacking. We performed a retrospective study of adults (≥ 18 years) with candidemia diagnosed in our center in 2010–2015. Demographics, comorbidities, clinical and microbiologic characteristics, antifungal treatment and outcome were compared between older (≤65 years) and younger (>65 years) patients. Among 302 patients with candidemia identified during the study period, 188 (62%) belonged to the elderly group. Comorbidities were significantly more frequent in older patients and included chronic pulmonary diseases, cardiovascular diseases, diabetes mellitus, and chronic renal failure (p ranging from <0.0001 to 0.017). A significantly higher proportion of older patients had septic shock (p = 0.040) at the time of candidemia. Candida albicans accounted for 53% of isolates and there were no significant differences between patients’ age and Candida species. Thirty-day mortality was significantly higher in older (45%) than in younger (28%) patients (p = 0.003). Factors associated with a significant higher proportion of death in the elderly included older age (i.e.: old-old), being hospitalized in ICU rather than in other wards, suffering from chronic pulmonary diseases, the presence of septic shock, multiple organ failure, dialysis and being infected with C. glabrata (p ranging from <0.0001 to 0.034). On multivariate analysis septic shock (HR 1.744 [CI95% 1.049–2.898], p = 0.032) and multiple organ failure (HR 2.242 [CI95% 1.070–4.698], p = 0.032) were independently associated with a higher risk of death. The probability of 30-days survival of older patients was significantly reduced when compared to that of younger patients (p = 0.005) who did not receive any treatment. In the elderly, there was a trend toward higher MICs for fluconazole/C. albicans, fluconazole/C. glabrata, amphotericin B/C. albicans, and caspofungin/C. glabrata. In our study, we found that elderly patients with Candida bloodstream infections are characterized by a high mortality rate. In particular, the lack of any antifungal therapy as well as the occurrence of septic shock increased significantly the overall mortality. Additionally, we found that there was a trend of higher MIC for specific drug/Candida combination.