Nosocomial candidemia at a general hospital: prognostic factors and impact of early empiric treatment on outcome (2002-2005)

作者：Gomez Joaquin; Garcia Vazquez Elisa^*; Espinosa Cristina; Ruiz Joaquin; Canteras Manuel; Hernandez Torres Alicia; Banos Victor; Herrero Jose Antonio; Valdes Mariano

来源：Medicina Clinica, 2010, 134(1): 1-5.

DOI：10.1016/j.medcli.2009.06.066

• Nosocomial candidemia
• Candida sp.
• Mortality
• Prognosis factors
• Treatment

Objectives: To evaluate epidemiological and clinical prognosis factors related to mortality and impact of early empiric treatment on patients with nosocomial candidemia (NC).
Patients and methods: Observational study of a cohort of 107 adult patients with NC admitted at a tertiary hospital (2002-5).
Results: In bivariate analysis, risk factors significantly associated with mortality rate (49.5%) were: age >65 years, previous steroid treatment, solid organ transplant, acute severity of illness, shock, renal failure and respiratory distress at onset, delayed or inadequate antifungal treatment, non-removal of central venous catheter and associated post-surgical bacterial sepsis or respiratory infection. In multivariate analysis, risk factor associated with mortality was acute severity of illness at onset (OR 76.9; CI 12.5-500) being early and adequate treatment (OR 11.8; CI 1.7-81.2) and early ( <48 h) removing of central venous catheter (OR 12.2; CI 1.9-74.9) factors associated with cure; there was no statistically significant difference between fungistatic (azoles) or fungicidal (amphotericin or caspofungin) treatment.
Conclusions: Acute severity of illness at onset is associated with mortality in patients with NC whereas early and adequate treatment and early removing of central venous catheter are associated with cure.

• 出版日期2010-1-23