Objective To investigate the clinical characteristics and Candida species distribution of patients with candi-demia,and to explore the risk factors for prognosis and construct a predictive model.Methods The candidemia cases from January 1,2017 to December 31,2022 were retrospectively analyzed,and their clinical features,microbiology,underlying diseases,treatment and 30 days outcomes were described by chart review.The univariate and multivariate logistic regression analyses were identified and were used to construct a predictive model.Results During the observation period,a total of 60 cases were enrolled,including 35 males(58.33％)and 25 females(41.67％).The mean age was(56.65±24.02)years,and 35 cases(63.52％)were elderly(61-100 years).The mean incidence of candidemia was 1.6 cases per 10 000 inpatients.42 cases(65.22％)were hospital acquired infection.45 cases(75.00％)had been given broad-spectrum antibiotics 30 days be-fore onset of the candidemia.25 cases(41.67％)underwent surgery 30 days before onset.38 cases(63.33％)had indwell-ing central venous catheters and 31 cases(51.67％)had indwelling urinary catheters.Candida albicans was predominantly,followed by Candida tropical.54 patients received at least one dose of antifungal drug,and the mean time of initiation of an-tifungal therapy was(1.68±2.84)days after onset.Micafungin was the primary antifungal agent.Among the enrolled ca-ses,29 cases(48.33％)survived with mean age of(52.90±26.66)years,and 31 cases(51.67％)died with mean age of(60.00±21.11)years.Univariate analysis revealed that hypertension,unconsciousness,lymphopenia and thrombocytopenia were associated with death.On the other hand,removal of central venous catheter within 48 hours and early use of adequate antifungal agent were associated with survival.Multivariate analysis showed that hypertension(OR=18.02,P=0.025),unconsciousness(OR=22.07,P=0.059),lymphopenia(OR=3.79,P=0.294),and thrombocytopenia(OR=8.47,P=0.073)were independent risk factors for death of candidemia.However,removal of central venous catheter within 48 hours(OR=0.46,P=0.346)and early use of adequate antifungal agent(OR=0.17,P=0.400)were protective factors.Conclusion The case fatality rate of candidemia has remained high.Candida albicans is the predominant pathogen.Hyper-tension,unconsciousness,lymphopenia and thrombocytopenia are independent risk factors for death,while removal of cen-tral venous catheter within 48 hours and early use of adequate antifungal agent are protective factors.This predictive model may help doctors in managing candidemia patients.
关键词
念珠菌血症/临床特征/预后/危险因素/风险预测模型
Key words
candidemia/clinical characteristics/prognosis/risk factors/risk prediction model
维普
万方数据