念珠菌菌血症的治療成效與死亡危險因子分析

The Outcome and Mortality Risk Factors in Patients with Candidemia

10.6200/TCMJ.201903_16(1).0008

方喬玲(Chiao- Ling Fang)；吳淑娟(Shu-Chuan Wu)；陳立奇(Lih-Chi Chen)

念珠菌菌血症 ； 抗黴菌藥品 ； 危險因子 ； antifungal agent ； candidemia ； mortality

北市醫學雜誌

16卷1期（2019 / 03 / 30）

67 - 74

繁體中文

目的：本文旨在探討念珠菌菌血症病人治療之處方模式、感染念珠菌菌血症之死亡率及影響死亡的危險因子。方法：回溯2014年1月至2016年12月間確診為念珠菌菌血症成年病人之資料進行分析，觀察治療後最終的死亡率。結果：共收納60位病人，平均年齡71.213.5歲，念珠菌菌血症的感染菌種以非白念珠菌居多（58.3%），血液中已無念珠菌時，持續治療14天以上者死亡率較低（p=0.0009），伴有敗血性休克（0.001）、惡性腫瘤病史（p=0.015）、75歲以上（p=0.021）、曾使用廣效性抗生素（P=0.009）為死亡相關的獨立危險因子，整體死亡率為40%。Fluconazole、Caspofungin、Lipo-Amphotericin B投予適當劑量的比率為85.5%、53%、100%。結論：念珠菌菌血症死亡率高，對於高風險的病人，及早投與適當的藥品與劑量，血液培養陰性後再治療14天，可降低死亡率。

Objective: This study aimed to explore the prescription model and mortality rate of Candidemia, and risk factors that affect the mortality rate of Candidemia. Methods: Data of mortality after treatment among adult patients confirmed with Candidemia between January 2014 and December 2016 were traced and analyzed retrospectively. Results: Sixty patients with an average age of 71.2 13.5 years were enrolled in this study. Non-albicans Candida is most common species of infection in our hospital. The all-cause mortality rate was 40%. Multivariate analysis on the all-cause mortality showed that patients treated 2 weeks continuously had lower mortality (P=0.0009), while septic shock (P=0.001), a disease history of malignancy (P=0.015), older than 75 years (P=0.021), and prior exposure to broad-spectrum antibiotics (P=0.009) were independent risk factors of mortality. The rate of proper dose of Fluconazole, Caspofungin, and Lipo-Amphotericin B were 85.5%, 53%, and 100%. Conclusion: The mortality rate of candidemia was high. Early drug intervention with proper dosage and additional 14 days treatment after negative results in blood culture reduced the mortality.