카테터 집락화가 없는 지속성 캔디다혈증의 위험인자와 예후

채윤태,정수진,구남수,백지현,김혜원,김선빈,윤지현,진성준,한상훈,송영구,김준명,최준용 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.4

Background: Candidemia is one of the most common causes of nosocomial bloodstream infection, and increases the morbidity and mortality rate of seriously ill patients. We evaluated the risk factors and outcomes associated with persistent candidemia without catheter colonization (non-catheter related candidemia) and compared them with those of non-persistent candidemia. Materials and Methods: A retrospective case-control study was performed to identify risk factors for, and outcomes of, persistent candidemia. All adults who experienced candidemia in a university-affiliated hospital in Korea between January 2005 and December 2009 were included. Patients with catheter colonization were excluded. Persistent candidemia was defined as the occurrence of candidemia in a patient receiving at least 3 days of systemic antifungal agents prior to the second positive blood culture. Results: Of 605 adult patients with candidemia, 104 (17.2%) patients had persistent candidemia and 23 (3.8%) patients were free of catheter colonization. There were no statistically significant differences in baseline characteristics between patients with persistent and non-persistent candidemia. In univariate analysis, less use of metronidazole, glycopeptide, fluoroquinolone, and aminoglycoside, and presence of Candida parapsilosis were significantly associated with persistent candidemia. In multivariate analysis, less use of metronidazole was an independent factor associated with persistent candidemia. The candidemia related mortality was insignificantly (P =0.094) higher in persistent candidemia than non-persistent candidemia. Conclusions: Persistent candidemia can occur without catheterization. Patterns of antibiotic use could be associated with the occurrence of persistent candidemia,and prognosis of persistent candidemia seems to be worse than non-persistent candidemia. Further studies for persistent candidemia should be performed.

Clinical characteristics and risk factors for mortality in adult patients with persistent candidemia

Kang, Seung Ji,Kim, Seong Eun,Kim, Uh Jin,Jang, Hee-Chang,Park, Kyung-Hwa,Shin, Jong Hee,Jung, Sook In Elsevier 2017 The Journal of infection Vol.75 No.3

<P><B>Summary</B></P> <P><B>Background</B></P> <P>We investigated the clinical characteristics and risk factors for mortality in adults with persistent candidemia.</P> <P><B>Methods</B></P> <P>All patients ≥18 years old with candidemia in two Korean tertiary hospitals from 2007 to 2014 were investigated. Persistent candidemia was defined as isolation of the same <I>Candida</I> species ≥5 days after initiation of antifungal therapy. Non-persistent candidemia was defined as candidemia persisting for ≤3 days after initiation of antifungal therapy.</P> <P><B>Results</B></P> <P> <I>Candida tropicalis</I> (29.2%) was the most common pathogen in persistent candidemia, and <I>Candida albicans</I> (35.9%) was the most common in non-persistent candidemia. Central venous catheter (CVC) (OR, 1.99; 95% CI, 1.05–3.78; <I>P</I> = 0.034), longer hospital stay (OR 1.01; 95% CI, 1.01–1.02; <I>P</I> = 0.025), and severe sepsis (OR 2.25; 95% CI, 1.11–4.56; <I>P</I> = 0.024) were independent risk factors for persistent candidemia. <I>C</I>. <I>tropicalis</I> was independently related to 30-day mortality (OR, 4.12; 95% CI, 1.27–13.36; <I>P</I> = 0.018), together with septic shock (OR, 5.81; 95% CI, 1.32–24.70; <I>P</I> = 0.017) and use of a corticosteroids (OR, 5.31; 95% CI, 1.07–26.29; <I>P</I> = 0.041) in persistent candidemia.</P> <P><B>Conclusion</B></P> <P> <I>C</I>. <I>tropicalis</I> is the predominant pathogen and cause of death in patients with persistent candidemia.</P> <P><B>Highlights</B></P> <P> <UL> <LI> <I>Candida tropicalis</I> was the most common pathogen in adult with persistent candidemia. </LI> <LI> CVC and severe sepsis were independently associated with persistent candidemia. </LI> <LI> <I>C. tropicalis</I> was a risk factor for mortality in persistent candidemia. </LI> </UL> </P>

카테터 집락화가 없는 지속성 캔디다혈증의 위험인자와 예후

채윤태,정수진,구남수,백지현,김혜원,김선빈,윤지현,진성준,한상훈,송영구,김준명,최준용 대한감염학회 2012 Infection and Chemotherapy Vol.44 No.1

Background: Candidemia is one of the most common causes of nosocomial bloodstream infection, and increases the morbidity and mortality rate of seriously ill patients. We evaluated the risk factors and outcomes associated with persistent candidemia without catheter colonization (non-catheter related candidemia) and compared them with those of non-persistent candidemia. Materials and Methods: A retrospective case-control study was performed to identify risk factors for, and outcomes of, persistent candidemia. All adults who experienced candidemia in a university-affiliated hospital in Korea between January 2005 and December 2009 were included. Patients with catheter colonization were excluded. Persistent candidemia was defined as the occurrence of candidemia in a patient receiving at least 3 days of systemic antifungal agents prior to the second positive blood culture. Results: Of 605 adult patients with candidemia, 104 (17.2%) patients had persistent candidemia and 23 (3.8%) patients were free of catheter colonization. There were no statistically significant differences in baseline characteristics between patients with persistent and non-persistent candidemia. In univariate analysis, less use of metronidazole, glycopeptide, fluoroquinolone, and aminoglycoside, and presence of Candida parapsilosis were significantly associated with persistent candidemia. In multivariate analysis, less use of metronidazole was an independent factor associated with persistent candidemia. The candidemia related mortality was insignificantly (P =0.094) higher in persistent candidemia than non-persistent candidemia. Conclusions: Persistent candidemia can occur without catheterization. Patterns of antibiotic use could be associated with the occurrence of persistent candidemia, and prognosis of persistent candidemia seems to be worse than non-persistent candidemia. Further studies for persistent candidemia should be performed.

Risk Factors for Mortality in Patients with Candidemia and the Usefulness of a Candida Score

문인기,강효철,유시내,위지완,김태형,추은주,전민혁,박세윤,이은정 대한의진균학회 2013 대한의진균학회지 Vol.18 No.3

Background: Although effective antifungal agents for the treatment of candidemia have recently been introduced, the mortality rate attributed to candidemia remains high (19~49%). Objective: This study aimed at evaluating the risk factors for mortality in patients with candidemia and at assessing the usefulness of a Candida Score in these patients. Methods: A cohort of patients with positive blood cultures for Candida species was retrospectively analyzed at Soonchunhyang University Hospital, a 750-bed teaching hospital, from May 2003 to February 2012. The Candida Score was calculated by assigning 1 point to any of total parenteral nutrition (TPN),surgery, or multifocal Candida species colonization, and 2 points to severe sepsis. Results: Sixty patients (68.3% men; mean age (standard deviation [SD]), 61.8 [18.9] years) with blood cultures positive for Candida species were identified. Most patients had been admitted to an intensive care unit (48 [80%]), were receiving broad-spectrum antibiotics (37 [61.7%]), had TPN (29[48.3%]), had diabetes mellitus (23 [38.3%]), and were receiving hemodialysis (10 [16.7%]). The mean (SD) Acute Physiology and Chronic Health Evaluation II (APACHE II) score was 19.60 (8.8). Twentythree patients (38.3%) had a Candida Score >2.5. The Candida species causing infection included C. albicans (41 [68.3%]), C. tropicalis (7 [11.7%]), C. parapsilosis (4 [6.7%]), C. krusei (3 [5%]), C. glabrata (3 [5%]), C. guilliermondii (1 [1.7%]), and C. catenulata (1 [1.7%]). Only 32 patients (53.3%)received adequate antifungal treatment. The candidemia-related mortality rate was 61.7% (n = 37patients). Multivariate logistic regression analysis demonstrated that a high APACHE II score (adjusted odds ratio [aOR], 1.2; 95% confidence interval [95% CI], 1.0~1.3; p = 0.01), presence of a malignancy (aOR, 14.8; 95% CI, 2.5~88.0; p = 0.003), and treatment with an antifungal agent (aOR, 0.2; 95% CI,0.0~1.0; p = 0.048) were associated with disease-related mortality. Conclusion: The risk factors for mortality in patients with candidemia are a high APACHE II scores and presence of a malignancy. However, the sensitivity of the Candida Score was not high (38.3%). New methods to rapidly identify candidemia and avoid delays in treatment with appropriate antifungal therapy are needed.

Evaluation of the early fluconazole treatment of candidemia protocol with automated short message service alerts: a before-and-after study

( Jeong Rae Yoo ),( Bo Ra Shin ),( Sujin Jo ),( Sang Taek Heo ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.3

Background/Aims: We introduced the Early Fluconazole Treatment in Candidemia (EFTC) protocol in August 2015 to improve the outcomes of patients with candidemia. This study evaluated the effectiveness of the EFTC protocol. Methods: We conducted a retrospective before-and-after study among patients in the intensive care units and Hemato-Oncology and General Surgery wards of our hospital between January 2013 and December 2018. The EFTC protocol entailed sending an automatic notification by short message service, feedback to the responsible healthcare worker, and regular standardized education of medical staff. On receiving a notification, physicians prescribed empirical fluconazole immediately. The effectiveness of the EFTC protocol was evaluated by multivariate analysis of risk factors for 30-day mortality. Results: Of 103 patients with candidemia, 50 were admitted before (pre-EFTC group) and 53 were admitted after (post-EFTC group) the introduction of the EFTC protocol. Patients’ mean age ± SD was 67.1 ± 18.6 years, and 55 (53.4%) were male. The mean ± SD time from Candida isolation to antifungal drug administration in the pre-EFTC and post-EFTC groups was 89.1 ± 73.6 and -9.8 ± 63.9 minutes, respectively (p = 0.01). The 30-day mortality in the pre-EFTC and post-EFTC groups was 54.5% (95% confidence interval [CI], 42.3 to 66.7), and 37.6% (95% CI, 26.1 to 49.1), respectively (p = 0.05). In the multivariate analysis, implementation of the EFTC protocol was independently associated with a reduction in 30-day mortality (odds ratio, 0.27; 95% CI, 0.12 to 0.63; p = 0.01). Conclusions: The early f luconazole treatment, monitoring, and education were effective in reducing mortality in patients with candidemia.

Late Onset Candida albicans Spondylodiscitis Following Candidemia: A Case Report

이정환,조정기,최수미 대한의진균학회 2017 대한의진균학회지 Vol.22 No.3

Candida albicans infections of the spine are relatively uncommon in spite of the increasing frequency of predisposing factors. Moreover, late onset spondylodiscitis after bloodstream candidiasis is extremely rare. A 66-year-old woman to have been underwent chemotherapy was diagnosed with candidemia. Antifungal agent was administrated until two weeks after no detection of fungus in the blood culture. The chemotherapy was continued. But, she was hospitalized due to abdominal pain and diarrhea. Pseudomembranous colitis was diagnosed. After metronidazole administration, she was improved and discharged. However, she revisited because of back pain and fever. Spondylitis and discitis on the 10th~11th thoracic spine was shown in magnetic resonance images. Open curettage and spinal stabilization was performed. C. albicans was identified. Antifungal agent was administrated and the patient improved well postoperatively. We present a rare case of late onset Candida spondylodiscitis after candidemia with review of the literatures.

Insidious Onset Multifocal Chest Wall and Spinal Abscess Caused by Previous Candidemia: A Case Report

Da Eun Kwon,Song Soo Kim,Shinhye Cheon,Jin Hwan Kim,Hyeyoung Kwon 대한영상의학회 2023 대한영상의학회지 Vol.84 No.5

Abscess formation due to Candida albicans infection is extremely rare. Radiological diagnosis of an atypical abscess at an uncommon site is challenging. In this study, we present a case of insidious onset multifocal chest wall and spinal abscess after candidemia in a young woman in the intensive care unit due to postpartum bleeding.

Distribution and Antifungal Susceptibilities of Candida Species Isolated from Blood Cultures from 2016 to 2023 years

홍승복 대한의생명과학회 2024 Biomedical Science Letters Vol.30 No.2

The aim of this study was to investigate the distribution and antifungal susceptibilities of Candida spp. from blood culture to provide useful information on empirical treatment of Candidemia. We investigated distribution and antifungal susceptibilities of Candida spp. isolated from blood culture during an 8-years (2016-2023) in a C-University hospital. Over 8 years, 1,182 Candida strains from blood culture were isolated, which was fourth most common cause of bloodstream infection. Among nonduplicated 350 Candida strains, C. albicans was the most common with 45.43%, followed by C. glabrata (17.43%), C. tropicalis (17.43%), C. parapsilosis (14.86%), C. guilliermondii (1.71%), C. krusei (0.86%), C. lusitaniae (0.86%), C. ciferrii (0.57%). In the antifungal susceptibility testing on 323 Candida strains, the non-susceptibility rate was 2.48% for amphotericin B, 1,71% for flucytosine, 3.09% for fluconazole, 4.66% for voriconazole, 5.57% for caspofungin, and 0.62% for micafungin. In particular, C. albicans showed non-susceptibility of 8.23% to voriconazole, and C. glabrata showed 14.81% and 24.59% to fluconazole and caspofungin, respectively. These data showed that the prevalence of candidemia is very common, and antifungal resistance in Candida spp., especially C. glabrata, is increasing. Therefore, periodic surveillance of prevalence and antifungal susceptibility of blood culture is very important for clinical laboratory.

Blood Stream Infections by Candida glabrataand Candida krusei: A Single-Center Experience

( Hee Kyoung Choi ),( Su Jin Jeong ),( Han Sung Lee ),( Bum Sik Chin ),( Suk Hoon Choi ),( Sang Hoon Han ),( Myung Soo Kim ),( Chang Oh Kim ),( Jun Yong Choi ),( Young Goo Song ),( June Myung Kim ) 대한내과학회 2009 The Korean Journal of Internal Medicine Vol.24 No.3

Background/Aims: The increasing incidence of Candida glabrata and Candida krusei infections is a significant problem because they are generally more resistant to fluconazole. We compared the risk factors associated with C. glabrata and C. krusei fungemia with Candida albicans fungemia and examined the clinical manifestations and prognostic factors associated with candidemia. Methods: We retrospectively reviewed demographic data, risk factors, clinical manifestations, and outcomes associated with C. glabrata and C. krusei fungemia at a tertiary-care teaching hospital during a 10-years period from 1997 to 2006. Results: During the study period, there were 497 fungemia episodes. C. glabrata fungemia accounted for 23 episodes and C. krusei fungemia accounted for 8. Complete medical records were available for 27 of these episodes and form the basis of this study. Compared to 54 episodes of C. albicans fungemia, renal insufficiency and prior fluconazole prophylaxis were associated with development of C. glabrata or C. krusei fungemia. The overall mortality was 67%. The fungemia-related mortality of C. glabrata and C. krusei was higher than that of C. albicans (52 vs. 26%, p=0.021). Empirical antifungal therapy did not decrease the crude mortality. Multiple logistic regression analysis showed that high APACHE II scores, catheter maintenance, and shock were independently associated with an increased risk of death. Conclusions: Renal insufficiency and prior fluconazole prophylaxis were associated with the development of C. glabrata or C. krusei fungemia. Fungemia-related mortality of C. glabrata or C. krusei was higher than that of C. albicans. Outcomes appeared to be related to catheter removal, APACHE II scores, and shock. (Korean J Intern Med 2009;24:263-269)

Clinical Sensitivity of the (1–3)-β-D-glucan Test for Predicting Candidemia

Lee Yun Woo,Lim So Yun,Jin Sol,Park Hye Jin,Sung Heungsup,Kim Mi-Na,Bae Seongman,Jung Jiwon,Kim Min Jae,Kim Sung-Han,Lee Sang-Oh,Choi Sang-Ho,Kim Yang Soo,Chong Yong Pil 대한진단검사의학회 2023 Annals of Laboratory Medicine Vol.43 No.4

The sensitivity of the (1–3)-β-D-glucan (BDG) diagnostic test for candidemia varies in different clinical settings, and its usefulness in early diagnosis of candidemia is suboptimal. We evaluated the sensitivity of the test for early candidemia prediction. All adult patients with culture-proven candidemia who underwent a serum Goldstream Fungus (1–3)-β-D-Glucan Test within seven days prior to candidemia onset at a tertiary referral hospital between January 2017 and May 2021 were included. Any-positive BDG results within seven days prior to candidemia onset were obtained in 38 out of 93 (40.9%) patients. The positive rate increased when the test was performed near the day of candidemia onset (P=0.04) but reached only 52% on the day of candidemia onset. We observed no significant differences between BDG-positive and -negative groups in terms of underlying disease, risk factors for candidemia, clinical presentation, origin of candidemia, and 30-day mortality. Candida albicans was significantly associated with positive BDG results than with all-negative BDG results (P=0.04). The Goldstream BDG test is unreliable for candidemia prediction because of its low sensitivity. Negative BDG results in patients with a high risk of invasive candidiasis should be interpreted with caution.