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輔仁醫學期刊

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篇名 加護病房內念珠菌菌血症之老年病人的流行病學、菌種分佈與預後因子:一個多中心研究
卷期 19:1
並列篇名 Epidemiology, species distribution, and prognostic factors of candidemia in elderly patients in intensive care units - a multicenter study
作者 陳崇裕魏裕峰洪依利劉偉倫
頁次 012-023
關鍵字 念珠菌菌血症老年人預後因子加護病房廣效性抗生素非白色念珠菌菌種念珠菌candidemiaelderlyprognostic factorsintensive care unitsbroad-spectrum antibioticsnon-albicans Candida
出刊日期 202103
DOI 10.3966/181020932021031901002

中文摘要

背景與目的:念珠菌為引起重症病人血流感染之常見真菌,而免疫功能低下者與年長病人則具有更高的念珠菌感染風險。研究方法:本研究為一個多中心回溯性研究,收集了自2009年至2012年期間,台灣南部4間醫院的加護病房內,65歲以上念珠菌菌血症病人之數據。結果:總共收集了198名平均年齡77.9歲的病人進行了資料分析,平均查爾森共病症指標(Charlson comorbidity index, CCI)與第二代急性生理和慢性健康評分(APACHII score)分別為10.2 (± 3.3)與28.1 (±7.9)。在發生念珠菌菌血症時,我們發現青老年人罹患白色念珠菌菌血症的比率顯著地高於老老年人(71.8% vs. 53.1%, P=0.008),而整體加護病房和院內死亡率兩者分別為40.9%與64.6%。多變項分析得知加護病房念珠菌菌血症病人的死亡率與之前使用過廣效型抗生素有顯著相關性(P=0.039)。我們也發現高CCI評分的病人與近期接受腹部手術的病人較少比率感染非白色念珠菌菌血症。結論:在重症青老年病人與老老年病人中,我們發現念珠菌菌血症的臨床表現與菌種分布有明顯的差異性。病人之前有接受過廣效性抗生素是罹患念珠菌菌血症之危險因子,且會顯著的影響念珠菌菌血症病人之死亡率。

英文摘要

Background and purpose: Immunocompromised and elderly patients are at increasing risk of infection by Candida, a strain of fungus that can cause bloodstream infections in the critically ill. Methods: ICU patient data collected during 2009 to 2012 by four Southern Taiwanese hospitals was used to conduct a retrospective, multicenter study on candidemia patients older than 65 years of age. Results: Patient data for 198 patients was used for analysis. The mean age of all patients was 77.9. Mean Charlson comorbidity index (CCI) and APACHE II scores were 10.2 (± 3.3) and 28.1 (± 7.9), respectively. We found significantly higher rates of C. albicans candidemia in young-old patients compared to old-old patients (71.8% vs. 53.1%, P=0.008). Overall ICU and in-hospital mortality was 40.9% and 64.6%, respectively. Multivariate analysis found ICU mortality of candidemia patients to be significantly associated with prior exposure to broad spectrum antibiotics (P=0.039). Patients with high CCI scores and those who had recently undergone abdominal surgery were found to be less likely to contract non-albicans candidemia. Conclusion: We found significant differences between the clinical features and species distribution of candidemia in critically ill young-old and old-old patients. Prior exposure to broad spectrum antibiotics is a risk factor for candidemia, and also significantly impacts on mortality.

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