Analysis of patients suffering from fungemia of Candida parapsilosis adimitted in geriatric intensive care unit / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the clinical features of senile patients suffering from fungemia of Candida parapsilosis, and the effect and safety of antifungal therapy in treatment of this disease in geriatric intensive care unit (GICU). Methods The clinical data of patients with fungi positive either in peripheral blood culture or catheter culture admitted to the GICU of Tianjin Medical University General Hospital from November 2012 to June 2015 were retrospectively analyzed, of them 45 cases were of infection of Candida parapsilosis (parapsilosis group) and 15 cases infection of non-Candida parapsilosis (non-parapsilosis group). The clinical features of the two groups were collected, such as sex, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, timing of antifungal therapy, number of patients mechanical ventilation, concomitant disease, catheter-related infection, method of catheter-indwelling, levels of creatinine (Cr), hemoglobin (Hb), platelet count (PLT), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), etc.; the differences in above indicators were compared between the two groups; multifactor Cox-regression-analysis was used to analyze the risk factors that could affect the patients' prognosis; the patients' survival rates on 7, 14 and 28-day were calculated and compared between the two groups, and the therapeutic effects of different anti-fungal drugs on patients' survival rates and liver function damage were recorded and compared. Results The non-parapsilosis group had a higher rate in mechanical ventilation than parapsilosis group [73.3% (11/15) vs. 33.3% (15/45), P < 0.05], and in the comparisons of other clinical features, there were no statistical significant differences between the two groups (all P > 0.05). There were no statistical significant differences in survival rates in the duration of 7, 14 and 28 days between the two groups[7 days 82.2% (37/45) vs. 66.7% (10/15), 14 days 75.6% (34/45) vs. 60.0% (9/15), 28 days 66.7% (30/45) vs. 46.7% (7/15), all P > 0.05]. When the patients in parapsilosis group treated with echinocinomycin were compared with those treated with azolol, no statistical significant differences were found between the 2 types of therapy in the survival rates in the duration of 7, 14, and 28 days after treatment [7 days 100.0% (23/23) vs. 82.4% (14/17), 14 days 91.3% (21/23) vs. 76.5% (13/17), 28 days 78.3% (18/23) vs. 70.6% (12/17), all P > 0.05]. Multifactor Cox-regression-analyses showeddiabetes [odds ratio (OR) = 0.268, 95% confidence interval (95%CI) = 0.077 - 0.928, P = 0.038), infection of Candida parapsilosis (OR = 0.260, 95%CI = 0.072 - 0.946, P = 0.041), APACHE Ⅱ score (OR = 1.241, 95%CI = 1.051 - 1.466, P = 0.011) and SOFA score (OR = 1.405, 95%CI = 1.005 - 1.966, P = 0.047) were the risk factors affecting the prognosis of the patients. When the patients in parapsilosis group treated with echinocinomycin were compared with those treated with azolol, there were no statistical significant differences in incidences of aggravation of liver damage and newly developed liver damage (aggravation of liver damage 18.8% vs. 21.0%, newly developed liver damage 6.2% vs. 10.5%, both P > 0.05). Conclusion The patients with fungemia in GICU are mainly the infection of Candida parapsilosis, and diabetes, infection of parapsilosis, APACHE Ⅱ score and SOFA score are the risk factors affecting the prognosis of the patients.