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

在为期一年的全国监测项目中，采集了念珠菌的血液分离株。菌种分布：白色念珠菌41%，近缘念珠菌23%，格拉氏念珠菌18%，热带假丝酵母菌12%，克鲁斯假丝酵母菌2%。所有菌株对氟康唑的耐药率为7.8%，而新药伏立康唑和米卡方金对几乎所有菌株的耐药率均高于氟康唑。对与氟康唑耐药相关的人口学和临床因素的单因素分析显示，年龄、血液系统恶性肿瘤、中性粒细胞减少和免疫抑制具有统计学意义。多因素Logistic回归模型显示，只有血液系统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天存活率为68.4%。在生存预测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、最近的腹部手术、拔除中心静脉导管和使用适当的抗真菌治疗与预后显著相关。在多因素分析中，拔除中心静脉导管(优势比6.0；95%可信区间2.2~16.1；P&lt；0.001)和使用适当的治疗(优势比2.1；95%可信区间1.1~4.1；P=0.0 3)是诊断为念珠菌血流感染后存活的独立因素。这项工作是日本第一次在全国范围内进行大规模监测研究，以获得念珠菌血流感染的微生物学和临床数据。本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。

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.