지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
초록· 키워드
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Background: Although effective antifungal agents for the treatment of candidemia have recently been introduced, the mortality rate attributed to candidemia remains high (19~49%).
Objective: This study aimed at evaluating the risk factors for mortality in patients with candidemia and at assessing the usefulness of a Candida Score in these patients.
Methods: A cohort of patients with positive blood cultures for Candida species was retrospectively analyzed at Soonchunhyang University Hospital, a 750-bed teaching hospital, from May 2003 to February 2012. The Candida Score was calculated by assigning 1 point to any of total parenteral nutrition (TPN),surgery, or multifocal Candida species colonization, and 2 points to severe sepsis.
Results: Sixty patients (68.3% men; mean age (standard deviation [SD]), 61.8 [18.9] years) with blood cultures positive for Candida species were identified. Most patients had been admitted to an intensive care unit (48 [80%]), were receiving broad-spectrum antibiotics (37 [61.7%]), had TPN (29[48.3%]), had diabetes mellitus (23 [38.3%]), and were receiving hemodialysis (10 [16.7%]). The mean (SD) Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 19.60 (8.8). Twentythree patients (38.3%) had a Candida Score >2.5. The Candida species causing infection included C.
albicans (41 [68.3%]), C. tropicalis (7 [11.7%]), C. parapsilosis (4 [6.7%]), C. krusei (3 [5%]), C.
glabrata (3 [5%]), C. guilliermondii (1 [1.7%]), and C. catenulata (1 [1.7%]). Only 32 patients (53.3%)received adequate antifungal treatment. The candidemia-related mortality rate was 61.7% (n = 37patients). Multivariate logistic regression analysis demonstrated that a high APACHE II score (adjusted odds ratio [aOR], 1.2; 95% confidence interval [95% CI], 1.0~1.3; p = 0.01), presence of a malignancy (aOR, 14.8; 95% CI, 2.5~88.0; p = 0.003), and treatment with an antifungal agent (aOR, 0.2; 95% CI,0.0~1.0; p = 0.048) were associated with disease-related mortality.
Conclusion: The risk factors for mortality in patients with candidemia are a high APACHE II scores and presence of a malignancy. However, the sensitivity of the Candida Score was not high (38.3%).
New methods to rapidly identify candidemia and avoid delays in treatment with appropriate antifungal therapy are needed.
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참고문헌 (19)
참고문헌 신청
Blot S / 2001 / Outcome in critically ill patients with candidal fungaemia: Candida albicans vs. Candida glabrata / J Hosp Infect 47 : 308 ~ 313
Cornwell EE, 3rd / 1995 / The pattern of fungal infections in critically ill surgical patients / Am Surg 61 : 847 ~ 850
Edmond MB / 1999 / Nosocomial bloodstream infections in United States hospitals: a three-year analysis / Clin Infect Dis 29 : 239 ~ 244
Fraser VJ / 1992 / Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality / Clin Infect Dis 15 : 414 ~ 421
Garey KW / 2006 / Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study / Clin Infect Dis 43 : 25 ~ 31
Cornwell EE, 3rd / 1995 / The pattern of fungal infections in critically ill surgical patients / Am Surg 61 : 847 ~ 850
Edmond MB / 1999 / Nosocomial bloodstream infections in United States hospitals: a three-year analysis / Clin Infect Dis 29 : 239 ~ 244
Fraser VJ / 1992 / Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality / Clin Infect Dis 15 : 414 ~ 421
Garey KW / 2006 / Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study / Clin Infect Dis 43 : 25 ~ 31
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