使用不同的断点定义评估适当的抗真菌治疗与念珠菌血症患者死亡率之间的关系。在一项回顾性研究中,我们将2009年至2015年期间所有念珠菌血症的成年人纳入了三级中心.我们定义了三个版本的适当(覆盖)抗真菌治疗,根据临床和实验室标准协会(CLSI)2008,CLSI2012和欧洲抗菌药物敏感性试验委员会(EUCAST)(2017年更新)断点.对于经验性治疗,我们评估了与30日死亡率的相关性.对于确定性治疗,我们评估了念珠菌菌血症发病后第一周存活的患者与90日死亡率的相关性.报告了具有95%置信区间的双变量逻辑回归的调整后比值比(OR)。我们确定了302例患者的308例念珠菌血症发作。30天的粗死亡率为55%(168/308)。对Anidulafungin的耐药性从3.5%增加到51.6%,对氟康唑的耐药性从15.2%增加到44.1%,当应用CLSI2008和EUCAST定义时,分别。使用CLSI2008定义,适当的经验性治疗与较低的30天死亡率显着相关,调整后OR0.56(0.33-0.96)。这些协会是相似的,尽管对EUCAST没有统计学意义,0.58(0.33-1.00),和CLSI2012,OR0.62(0.37-1.04)。根据CLSI2012和EUCAST,适当的确定性治疗与90天死亡率较低独立相关。ORs0.31(0.13-0.75)和0.44(0.23-0.8),分别。与CLSI2008,关联相似,但无统计学意义,或0.4(0.11-1.41),几乎没有被分类为耐药的分离株。考虑到应用CLSI2008、CLSI2012和EUCAST断点定义时耐药率的重大变化,在与死亡率的相关性方面没有观察到重大差异.
To evaluate the association between appropriate antifungal treatment and mortality among patients with candidemia using different breakpoint definitions. In a retrospective
study, we included all adults with candidemia in a tertiary center between 2009 and 2015. We defined three versions of appropriate (covering) antifungal treatment, according to Clinical and Laboratory Standards Institute (CLSI) 2008, CLSI 2012, and European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2017 update)
breakpoints. For empiric treatment, we evaluated the association with 30-day mortality. For definitive treatment, we evaluated the association with 90-day mortality among patients surviving the first week after candidemia onset. Adjusted odds ratios (OR) from a bivariate logistic regression with 95% confidence intervals are reported. We identified 302 patients with 308 separate candidemia episodes. The crude 30-day mortality was 55% (168/308). Resistance to anidulafungin increased from 3.5 to 51.6% and to fluconazole from 15.2 to 44.1%, when applying CLSI 2008 and EUCAST definitions, respectively. Appropriate empirical treatment was significantly associated with lower 30-day mortality using the CLSI 2008 definitions, adjusted OR 0.56 (0.33-0.96). The associations were similar, though not statistically significant for EUCAST, 0.58 (0.33-1.00), and CLSI 2012, OR 0.62 (0.37-1.04). Appropriate definitive treatment according to CLSI 2012 and EUCAST was independently associated with lower 90-day mortality, ORs 0.31 (0.13-0.75) and 0.44 (0.23-0.8), respectively. With CLSI 2008, the association was similar but not statistically significant, OR 0.4 (0.11-1.41), with few isolates classified as resistant. Considering the major shift in resistance prevalence when applying CLSI 2008, CLSI 2012, and EUCAST breakpoint definitions, no major differences were observed in their association with mortality.