Risk factor analysis associated with unfavorable treatment outcomes in invasive candidiasis

[S. R. Popović]

60 listova

Uvod/Cilj: Najčešća invazivna gljivična infekcija kod ljudi je invazivna kandidijaza. Bolest se ispoljava kao kandidemija, a mogu biti zahvaćeni unutrašnji organi sa razvojem sepse i septičnog šoka. Poznavanje faktora koji dovode do morbiditeta i mortaliteta ovih bolesnika je od velikog značaja. Cilj našeg istraživanja je bio da istražimo faktore povezane sa smrtnim ishodom bolesnika sa invazivnom kandidijazom, koji su lečeni u našoj ustanovi. Metode: Retrospektivna kohortna studija je sprovedena u Vojnomedicinskoj akademiji u Beogradu, Srbija, od 2008. do 2021. godine. Istraživanjem je obuhvaćeno 145 bolesnika, muškaraca i žena, starijih od 18 godina, sa dokazanom dijagnozom invazivne kandidijaze. Demografija, komorbiditeti, primena terapijskih procedura, antibiotici, antifungalni tretman i ishod su upoređeni između umrlih i preživelih bolesnika sa invazivnom kandidijazom. Rezultati su analizirani primenom, Mann Whitney U testa, Studentov t-testa i modelom univarijantne i multivarijantne regresione statističke analize. Rezultati: Analizom rezultata smo ustanovili da su glavni uzroci smrtnog ishoda kod bolesnika sa invazivnom kandidijazom, dijabetes melitus (prilagođeno OR 6.886; CI 2.608-18.178; p=0.000) i hemoterapija (prilagođeno OR 6.826; 95% CI: 2.037-22.866; p= 0.002). Dijabetes melitus i hemoterapija povećavaju rizik za smrtni ishod 7 puta u poređenju sa bazalnim rizikom, dok mehanička ventilacija, povećava rizik za smrtni ishod oko 3 puta (prilagođeno OR: 3.056; 95% CI: 1.132-8.253; p=0.012). Zaključak: Rano otkrivanje i identifikacija uzročnika invazivne kandidijaze omogućava optimalan tretman, posebno kod imunokompromitovanih bolesnika. Evidentiranje faktora rizika za nepovoljan ishod i brz početak odgovarajuće terapije, povećava preživljavanje ovih bolesnika

Introduction/aim: The most common invasive fungal infection in humans is invasive candidiasis. The disease manifests as candidemia, and internal organs may be affected with the development of sepsis and septic shock. Knowledge of the factors leading to morbidity and mortality in these patients is of great importance. The aim of our study was to determine the factors associated with death in patients with invasive candidiasis treated at our institution. Methods: A retrospective cohort study was conducted at the Military Medical Academy in Belgrade, Serbia, between 2008 and 2021. The study included 145 patients, men and women, older than 18 years, diagnosed with invasive candidiasis. Demographic data, comorbidities, use of therapeutic procedures, antibiotics, antifungal treatment and outcomes were compared between deceased and surviving patients with invasive candidiasis. Results were analyzed using the Mann-Whitney U test, Student's t-test, and univariate and multivariate statistical regression analysis model. Results: Analysis of the results showed that the main causes of death in patients with invasive candidiasis were diabetes mellitus (adjusted OR 6.886; CI 2.608-18.178; p=0.000) and chemotherapy (adjusted OR 6.826; 95% CI: 2.037-22.866; p = 0.002). Diabetes mellitus and chemotherapy increased the risk of death by 7-fold compared to the baseline risk, while mechanical ventilation increased the risk of death by 3-fold (adjusted OR: 3.056; 95% CI: 1.132-8.253; p=0.012). Conclusion: Early detection and identification of the causative agent of invasive candidiasis enables optimal treatment, especially in immunocompromised patients. The detection of risk factors for an unfavorable course and the rapid initiation of appropriate therapy increases the survival of these patients.

gljivična infekcija, invazivna kandidijaza, dijabetes melitus, smrt

fungal infection, invasive candidiasis, diabetes mellitus, death

616.98-005.52(043.3)

Infektologija

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