Abstract：
OBJECTIVE: 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.
METHODS: 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.
CONCLUSIONS: Early source control was associated with better outcome among candidemic critically ill patients.
METHODS: Multicenter retrospective study.
METHODS: 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.
CONCLUSIONS: Early source control was associated with better outcome among candidemic critically ill patients.
摘要：
目的：念珠菌菌血症与高死亡率相关，尤其是在危重患者中。我们的目的是确定念珠菌血症危重患者死亡率的预测因素，重点是可以改善预后的早期干预措施。
方法：多中心回顾性研究。
方法：这项回顾性研究于2015年至2021年在三家欧洲大学医院的重症监护病房进行。至少有一种念珠菌血培养阳性的成年患者。包括在内。不需要源控制的患者被排除。主要结果是14天死亡率。
结果：共纳入409次念珠菌血症。大多数念珠菌与导管相关(173;41%)，其次是来历不明（170；40％）。43％的发作发生感染性休克。总的来说,14天死亡率为29%。在Cox比例风险回归模型中，感染性休克（P0.001；HR2.20，CI1.38-3.50），SOFA评分≥10分（P0.008；HR1.83，CI1.18-2.86），和先前的SARS-CoV-2感染（P0.003;HR1.87，CI1.23-2.85）与14天死亡率相关，而联合早期适当的抗真菌治疗和来源控制（P<0.001;HR0.15，CI0.08-0.28），与没有早期适当抗真菌治疗或来源控制的患者相比，没有适当抗真菌治疗的早期来源控制（P<0.001;HR0.23，CI0.12-0.47）与更好的生存率相关。
结论：在念珠菌病危重患者中，早期源控制与更好的预后相关。
方法：多中心回顾性研究。
方法：这项回顾性研究于2015年至2021年在三家欧洲大学医院的重症监护病房进行。至少有一种念珠菌血培养阳性的成年患者。包括在内。不需要源控制的患者被排除。主要结果是14天死亡率。
结果：共纳入409次念珠菌血症。大多数念珠菌与导管相关(173;41%)，其次是来历不明（170；40％）。43％的发作发生感染性休克。总的来说,14天死亡率为29%。在Cox比例风险回归模型中，感染性休克（P0.001；HR2.20，CI1.38-3.50），SOFA评分≥10分（P0.008；HR1.83，CI1.18-2.86），和先前的SARS-CoV-2感染（P0.003;HR1.87，CI1.23-2.85）与14天死亡率相关，而联合早期适当的抗真菌治疗和来源控制（P<0.001;HR0.15，CI0.08-0.28），与没有早期适当抗真菌治疗或来源控制的患者相比，没有适当抗真菌治疗的早期来源控制（P<0.001;HR0.23，CI0.12-0.47）与更好的生存率相关。
结论：在念珠菌病危重患者中，早期源控制与更好的预后相关。
