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Clin Infect Dis：尿路相关念珠菌血症：棘白菌素vs氟康唑

2017-12-26 梁舒瑶 环球医学

尿路相关念珠菌血症棘白菌素氟康唑
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患者在住院期间常因诸多因素患上医院获得性感染。2017年发表在《Clin Infect Dis》的一项由西班牙和阿根廷科学家进行的多中心研究，比较了棘白菌素vs氟康唑治疗尿路相关念珠菌菌血症（CUTS）患者的结局。

患者在住院期间常因诸多因素患上医院获得性感染。2017年发表在《Clin Infect Dis》的一项由西班牙和阿根廷科学家进行的多中心研究，比较了棘白菌素vs氟康唑治疗尿路相关念珠菌菌血症（CUTS）患者的结局。

背景：棘白菌素是否能用于治疗CUTS尚不清楚。研究者旨在提供CUTS的流行病学信息，并比较棘白菌素与氟康唑治疗CUTS的结局。

方法：在9所医院开展一项针对念珠菌血症成人的多中心研究。CUTS定义为念珠菌血症，伴随与泌尿系统疾病显着相关的类似有机体念珠菌。评价的主要结局为接受棘白菌素或氟康唑治疗的患者中的治疗失败（定义为7天死亡率或持续念珠菌血症）。计算倾向评分，然后输入回归模型。

结果：在2176例念珠菌血症病例中，128例为CUTS（5.88%）。大部分CUTS病例由白色念珠菌引起（52.7%），其次是光滑念珠菌（25.6%）和热带念珠菌（16.3%）。7例（20%）使用棘白菌素的患者和15例（17.1%）使用氟康唑治疗的患者出现临床失败（P = 0.730）。急性肾衰（调整比值比[AOR]，3.01；95%置信区间[CI]，1.01～8.91；P = 0.047）是临床失败的唯一独立影响因素，而早期尿路引流术（手术、经皮或内镜）定义为前瞻性（AOR，0.08；95% CI，0.02～0.31；P＜0.001）单变量和多变量分析均没有显示棘白菌素疗法改善风险或治疗失败。

结论：初始棘白菌素治疗与CUTS患者的临床失败不相关。值得注意的是，急性肾衰预测结局恶化，早期进行泌尿手术室一种保护措施。

原始出处：
Cuervo G, Garcia-Vidal C, Puig-Asensio M, et al.Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis.Clin Infect Dis. 2017 May 15;64(10):1374-1379. doi: 10.1093/cid/cix033.

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    2018-06-19 tigerlr107

    #念珠菌#

    0

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    2018-02-13 cmj8wellington

    #Dis#

    0

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    2018-01-17 吴颖

    很好.学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1670575, encodeId=900d16e057553, content=<a href='/topic/show?id=c0425209338' target=_blank style='color:#2F92EE;'>#念珠菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52093, encryptionId=c0425209338, topicName=念珠菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3be826737448, createdName=tigerlr107, createdTime=Tue Jun 19 17:09:00 CST 2018, time=2018-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012539, encodeId=9e0b2012539cb, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Tue Feb 13 03:09:00 CST 2018, time=2018-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=279499, encodeId=bc822e9499be, content=很好.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Wed Jan 17 21:12:11 CST 2018, time=2018-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275838, encodeId=4c4f2e583890, content=客观性.公正性.讲得很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jan 05 22:58:33 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273826, encodeId=b5322e382638, content=了解了解.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sat Dec 30 10:19:16 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1303938, encodeId=616913039380e, content=<a href='/topic/show?id=d1a0880e7c8' target=_blank style='color:#2F92EE;'>#菌血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88077, encryptionId=d1a0880e7c8, topicName=菌血症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e5bc315, createdName=Tommy1949, createdTime=Thu Dec 28 12:09:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603295, encodeId=5c4316032955c, content=<a href='/topic/show?id=ba9a6392545' target=_blank style='color:#2F92EE;'>#氟康唑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63925, encryptionId=ba9a6392545, topicName=氟康唑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d68c19021189, createdName=yhj-time, createdTime=Thu Dec 28 12:09:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272749, encodeId=caa42e274905, content=学习了.从药代药动.不良反应上加以考虑选择, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Dec 26 21:26:19 CST 2017, time=2017-12-26, status=1, ipAttribution=)]
    2018-01-05 虈亣靌

    客观性.公正性.讲得很不错

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1670575, encodeId=900d16e057553, content=<a href='/topic/show?id=c0425209338' target=_blank style='color:#2F92EE;'>#念珠菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52093, encryptionId=c0425209338, topicName=念珠菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3be826737448, createdName=tigerlr107, createdTime=Tue Jun 19 17:09:00 CST 2018, time=2018-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012539, encodeId=9e0b2012539cb, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Tue Feb 13 03:09:00 CST 2018, time=2018-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=279499, encodeId=bc822e9499be, content=很好.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Wed Jan 17 21:12:11 CST 2018, time=2018-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275838, encodeId=4c4f2e583890, content=客观性.公正性.讲得很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jan 05 22:58:33 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273826, encodeId=b5322e382638, content=了解了解.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sat Dec 30 10:19:16 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1303938, encodeId=616913039380e, content=<a href='/topic/show?id=d1a0880e7c8' target=_blank style='color:#2F92EE;'>#菌血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88077, encryptionId=d1a0880e7c8, topicName=菌血症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e5bc315, createdName=Tommy1949, createdTime=Thu Dec 28 12:09:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603295, encodeId=5c4316032955c, content=<a href='/topic/show?id=ba9a6392545' target=_blank style='color:#2F92EE;'>#氟康唑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63925, encryptionId=ba9a6392545, topicName=氟康唑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d68c19021189, createdName=yhj-time, createdTime=Thu Dec 28 12:09:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272749, encodeId=caa42e274905, content=学习了.从药代药动.不良反应上加以考虑选择, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Dec 26 21:26:19 CST 2017, time=2017-12-26, status=1, ipAttribution=)]
    2017-12-30 1dd8c52fm63(暂无匿称)

    了解了解.继续关注

    0

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    2017-12-28 Tommy1949

    #菌血症#

    0

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    2017-12-28 yhj-time

    #氟康唑#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1670575, encodeId=900d16e057553, content=<a href='/topic/show?id=c0425209338' target=_blank style='color:#2F92EE;'>#念珠菌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52093, encryptionId=c0425209338, topicName=念珠菌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3be826737448, createdName=tigerlr107, createdTime=Tue Jun 19 17:09:00 CST 2018, time=2018-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2012539, encodeId=9e0b2012539cb, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c689267, createdName=cmj8wellington, createdTime=Tue Feb 13 03:09:00 CST 2018, time=2018-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=279499, encodeId=bc822e9499be, content=很好.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Wed Jan 17 21:12:11 CST 2018, time=2018-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275838, encodeId=4c4f2e583890, content=客观性.公正性.讲得很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jan 05 22:58:33 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=273826, encodeId=b5322e382638, content=了解了解.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sat Dec 30 10:19:16 CST 2017, time=2017-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1303938, encodeId=616913039380e, content=<a href='/topic/show?id=d1a0880e7c8' target=_blank style='color:#2F92EE;'>#菌血症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88077, encryptionId=d1a0880e7c8, topicName=菌血症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e5bc315, createdName=Tommy1949, createdTime=Thu Dec 28 12:09:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1603295, encodeId=5c4316032955c, content=<a href='/topic/show?id=ba9a6392545' target=_blank style='color:#2F92EE;'>#氟康唑#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63925, encryptionId=ba9a6392545, topicName=氟康唑)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d68c19021189, createdName=yhj-time, createdTime=Thu Dec 28 12:09:00 CST 2017, time=2017-12-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=272749, encodeId=caa42e274905, content=学习了.从药代药动.不良反应上加以考虑选择, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Dec 26 21:26:19 CST 2017, time=2017-12-26, status=1, ipAttribution=)]
    2017-12-26 惠映实验室

    学习了.从药代药动.不良反应上加以考虑选择

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