Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period.
Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period.
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DOI：
10.1007/s00134-014-3400-y
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发表时间：
2014-10
影响因子：
38.9
通讯作者：
Nucci, Marcio
中科院分区：
文献类型：
--
作者：
Colombo, Arnaldo L.;Guimares, Thais;Sukienik, Teresa;Pasqualotto, Alessandro C.;Andreotti, Ricardo;Queiroz-Telles, Flavio;Nouer, Simone A.;Nucci, Marcio
描述重症监护病房（ICU）患者念珠菌血症的流行病学、临床管理和结局的时间趋势。本研究回顾性分析了来自22家巴西医院的647例成人ICU患者的1，392例念珠菌血症。比较了两个时期（2003-2007年，第1期; 2008-2012年，第2期）这些ICU患者的念珠菌血症特征，并评估了30天死亡率的预测因素。在ICU期间发生念珠菌血症的患者比例从第1阶段的44%增加至第2阶段的50.9%（p = 0.01）。在第2阶段，念珠菌血症（22.3 vs. 11.6%，p < 0.001）和光滑念珠菌引起的真菌血症（13.1 vs. 7.8%，p = 0.03）之前暴露于氟康唑的患者比例更高，接受棘白菌素作为主要治疗的患者比例也更高（18.0 vs. 5.9%，p < 0.001）。30天死亡率从阶段1的76.4%下降到阶段2的60.8%（p < 0.001）。多变量分析的30天死亡率的预测因素是年龄较大、第1阶段、皮质类固醇治疗和较高的APACHE II评分，而棘白菌素治疗与较高的生存概率相关。 我们发现，在9年的研究期间，ICU患者念珠菌血症的流行病学和临床管理发生了明显变化。使用棘白菌素作为念珠菌血症的主要治疗似乎与更好的结果相关。
To describe temporal trends in the epidemiology, clinical management and outcome of candidemia in intensive care unit (ICU) patients. This study was a retrospective analysis of 1,392 episodes of candidemia in 647 adult ICU patients from 22 Brazilian hospitals. The characteristics of candidemia in these ICU patients were compared in two periods (2003–2007, period 1; 2008–2012, period 2), and the predictors of 30-day mortality were assessed. The proportion of patients who developed candidemia while in the ICU increased from 44 % in period 1 to 50.9 % in period 2 (p = 0.01). Prior exposure to fluconazole before candidemia (22.3 vs. 11.6 %, p < 0.001) and fungemia due to Candida glabrata (13.1 vs. 7.8 %, p = 0.03) were more frequent in period 2, as was the proportion of patients receiving an echinocandin as primary therapy (18.0 vs. 5.9 %, p < 0.001). The 30-day mortality rate decreased from 76.4 % in period 1 to 60.8 % in period 2 (p < 0.001). Predictors of 30-day mortality by multivariate analysis were older age, period 1, treatment with corticosteroids and higher APACHE II score, while treatment with an echinocandin were associated with a higher probability of survival. We found a clear change in the epidemiology and clinical management of candidemia in ICU patients over the 9-year period of the study. The use of echinocandins as primary therapy for candidemia appears to be associated with better outcomes.
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影响因子：
5.2
作者：
Delaloye J;Calandra T
通讯作者：
Calandra T
影响因子：
38.9
作者：
Leon, Cristobal;Ruiz-Santana, Sergio;Farinas, Osvaldo
通讯作者：
Farinas, Osvaldo
影响因子：
6.9
作者：
Playford, E. G.;Nimmo, G. R.;Sorrell, T. C.
通讯作者：
Sorrell, T. C.
影响因子：
8.8
作者：
Puig-Asensio, Mireia;Peman, Javier;Almirante, Benito
通讯作者：
Almirante, Benito
影响因子：
38.9
作者：
Bassetti, Matteo;Righi, Elda;Tumbarello, Mario
通讯作者：
Tumbarello, Mario