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Abstract：
We aimed to analyze whether the lack of inclusion of specific recommendations for the management of candidemia is an independent risk factor for early and overall mortality. Multicenter study of adult patients with candidemia in 13 hospitals. We assessed the proportion of patients on whom nine specific ESCMID and IDSA guidelines recommendations had been applied, and analyzed its impact on mortality. 455 episodes of candidemia were documented. Patients who died within the first 48 hours were excluded. Sixty-two percent of patients received an appropriate antifungal treatment. Either echinocandin or amphotericin B therapy were administered in 43% of patients presenting septic shock and in 71% of those with neutropenia. Sixty-one percent of patients with breakthrough candidemia underwent a change in antifungal drug class. Venous catheters were removed in 79% of cases. Follow-up blood cultures were performed in 72% of cases. Ophthalmoscopy and echocardiogram were performed in 48% and 50% of patients, respectively. Length of treatment was appropriate in 78% of cases. Early (2-7 days) and overall (2-30 days) mortality were 8% and 27.7%, respectively. Inclusion of less than 50% of the specific recommendations was independently associated with a higher early (HR = 7.02, 95% CI: 2.97-16.57; P < .001) and overall mortality (HR = 3.55, 95% CI: 2.24-5.64; P < .001). In conclusion, ESCMID and IDSA guideline recommendations were not performed on a significant number of patients. Lack of inclusion of these recommendations proved to be an independent risk factor for early and overall mortality.
摘要：
我们旨在分析缺乏针对念珠菌血症管理的具体建议是否是早期和总死亡率的独立危险因素。13家医院成人念珠菌血症患者的多中心研究。我们评估了应用了9项特定ESCMID和IDSA指南建议的患者比例，并分析了其对死亡率的影响。记录了455次念珠菌血症。在最初48小时内死亡的患者被排除在外。62%的患者接受了适当的抗真菌治疗。43％的脓毒性休克患者和71％的中性粒细胞减少症患者接受了棘白菌素或两性霉素B治疗。61％的突破性念珠菌菌血症患者发生了抗真菌药物类别的变化。79%的病例拔除静脉导管。72％的病例进行了随访血培养。48％和50％的患者进行了眼镜检查和超声心动图检查，分别。78％的病例治疗时间合适。早期（2-7天）和总体（2-30天）死亡率分别为8％和27.7％，分别。纳入不到50％的具体建议与较高的早期死亡率（HR=7.02，95％CI：2.97-16.57；P<.001）和总死亡率（HR=3.55，95％CI：2.24-5.64；P<.001）独立相关。总之,ESCMID和IDSA指南建议未对大量患者进行。缺乏这些建议被证明是早期和总死亡率的独立风险因素。
