Role of source control in critically ill candidemic patients: a multicenter retrospective study.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2024-10-01 Epub Date: 2024-03-12 DOI:10.1007/s15010-024-02222-z

Markos Marangos, Petros Ioannou, Laurence Senn, Anastasia Spiliopoulou, Sotiris Tzalis, Fevronia Kolonitsiou, Maria Valta, Sofia Kokkini, Jean-Luc Pagani, Dimitra Stafylaki, Fotini Paliogianni, Fotini Fligou, Diamantis P Kofteridis, Frédéric Lamoth, Matthaios Papadimitriou-Olivgeris

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引用次数: 0

Abstract

Purpose: Candidemia is associated with high mortality especially in critically ill patients. Our aim was to identify predictors of mortality among critically ill patients with candidemia with a focus on early interventions that can improve prognosis.

Methods: Multicenter retrospective study.

Setting: This retrospective study was conducted in Intensive Care Units from three European university hospitals from 2015 to 2021. Adult patients with at least one positive blood culture for Candida spp. were included. Patients who did not require source control were excluded. Primary outcome was 14-day mortality.

Results: A total of 409 episodes of candidemia were included. Most candidemias were catheter related (173; 41%), followed by unknown origin (170; 40%). Septic shock developed in 43% episodes. Overall, 14-day mortality rate was 29%. In Cox proportional hazards regression model, septic shock (P 0.001; HR 2.20, CI 1.38-3.50), SOFA score ≥ 10 points (P 0.008; HR 1.83, CI 1.18-2.86), and prior SARS-CoV-2 infection (P 0.003; HR 1.87, CI 1.23-2.85) were associated with 14-day mortality, while combined early appropriate antifungal treatment and source control (P < 0.001; HR 0.15, CI 0.08-0.28), and early source control without appropriate antifungal treatment (P < 0.001; HR 0.23, CI 0.12-0.47) were associated with better survival compared to those without neither early appropriate antifungal treatment nor source control.

Conclusion: Early source control was associated with better outcome among candidemic critically ill patients.

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源头控制在重症念珠菌病患者中的作用：一项多中心回顾性研究。

目的：念珠菌病与高死亡率有关，尤其是在重症患者中。我们的目的是确定念珠菌血症重症患者的死亡率预测因素，重点关注可改善预后的早期干预措施：多中心回顾性研究：这项回顾性研究于2015年至2021年在欧洲三家大学医院的重症监护病房进行。研究纳入了至少有一次念珠菌属血液培养呈阳性的成人患者。不需要源头控制的患者被排除在外。主要结果为 14 天死亡率：结果：共纳入了 409 例念珠菌血症。大多数念珠菌病与导管有关（173 例；41%），其次是来源不明（170 例；40%）。43%的病例发生了脓毒性休克。总体而言，14 天死亡率为 29%。在 Cox 比例危险度回归模型中，脓毒性休克（P 0.001；HR 2.20，CI 1.38-3.50）、SOFA 评分≥10 分（P 0.008；HR 1.83，CI 1.18-2.86）和既往 SARS-CoV-2 感染（P 0.003；HR 1.87，CI 1.23-2.85）与 14 天死亡率相关，而早期适当的抗真菌治疗和病源控制（P 0.002）与 14 天死亡率相关：在念珠菌感染的重症患者中，早期病源控制与更好的预后相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.