The impact of age on risk assessment, therapeutic practice and outcome in candidemia

被引：13

作者：

Hesstvedt, Liv ^{[1
,2
]}

Gaustad, Peter ^{[2
,3
,4
]}

Mueller, Fredrik ^{[3
,4
]}

Andersen, Cecilie Torp ^{[2
,3
]}

Brunborg, Cathrine ^{[5
]}

Mylvaganam, Haima ^{[6
]}

Leiva, Rafael Alexander ^{[7
]}

Berdal, Jan Erik ^{[8
]}

Ranheim, Trond Egil ^{[9
,18
]}

Johnsen, Bjorn Odd ^{[9
,19
]}

Falch, Birgit M. ^{[10
]}

Grimnes, Gro ^{[11
]}

Skogen, Vegard ^{[11
]}

Haarr, Elisebet ^{[12
]}

Lyngoy, Anita Sandmo ^{[13
]}

Larssen, Kjersti Wik ^{[14
]}

Hannula, Raisa ^{[15
]}

Hansen, Bjorn Asheim ^{[16
]}

Nordoy, Ingvild ^{[1
,17
]}

Torfoss, Dag ^{[20
]}

Gammelsrud, Karianne W. ^{[21
]}

Kanestrom, A. ^{[22
]}

Ringstad, Jetmund ^{[22
]}

Grub, Carola ^{[23
]}

Sandnes, Rolf Arne ^{[23
]}

Hagen, Ivar Jo ^{[23
]}

Schiotz, K. ^{[24
]}

Onken, Annette ^{[25
]}

Jenum, Pal ^{[25
]}

Ronning, Else Johanne ^{[25
]}

Skrede, Thomas ^{[26
]}

Skaare, Dagfinn ^{[27
]}

Tveten, Yngvar ^{[28
]}

Skudal, Hilde ^{[28
]}

Tofteland, Stale ^{[29
]}

Hoyvoll, Liv Ragnhild ^{[29
]}

Hjetland, Reidar ^{[30
]}

Hide, Reidar ^{[31
]}

Fuglestad, Solvor ^{[31
]}

Longva, Jorn Age ^{[31
]}

Kummel, Angela ^{[32
]}

Asheim, Sandra ^{[33
]}

Sundnes, Gunille Justad ^{[33
]}

Kols, Nicola Isabelle ^{[34
]}

机构：

[1] Oslo Univ Hosp, Rikshosp, Res Inst Internal Med, Oslo, Norway

[2] Oslo Univ Hosp, Rikshosp, Dept Microbiol, Oslo, Norway

[3] Oslo Univ Hosp, Norwegian Mycol Reference Lab, Oslo, Norway

[4] Univ Oslo, Inst Clin Med, Fac Med, Oslo, Norway

[5] Oslo Univ Hosp, Oslo Ctr Biostat & Epidemiol, Oslo, Norway

[6] Haukeland Hosp, FDepartment Microbiol, Bergen, Norway

[7] Haukeland Hosp, Dept Infect Dis, Bergen, Norway

[8] Akershus Univ Hosp, Dept Infect Dis, Lorenskog, Norway

[9] Akershus Univ Hosp, Dept Microbiol & Infect Control, Lorenskog, Norway

[10] Univ Hosp Northern Norway, Dept Microbiol, Tromso, Norway

[11] Univ Hosp Northern Norway, Dept Infect Dis, Tromso, Norway

[12] Univ Hosp Stavanger, Dept Med Microbiol, Stavanger, Norway

[13] Univ Hosp Stavanger, Dept Infect Dis, Stavanger, Norway

[14] Trondheim Reg & Univ Hosp, Dept Microbiol, Trondheim, Norway

[15] Trondheim Reg & Univ Hosp, Dept Infect Dis, Trondheim, Norway

[16] Vestfold Hosp Trust, Dept Infect Dis, Tonsberg, Norway

[17] Oslo Univ Hosp, Rikshosp, Sect Clin Immunol & Infect Dis, Oslo, Norway

[18] Furst Med Labs, Oslo, Norway

[19] Ringerike Hosp, Vestre Viken Hosp Trust, Dept Med, Honefoss, Norway

[20] Oslo Univ Hosp, DNR, Oslo, Norway

[21] Oslo Univ Hosp, Oslo, Norway

[22] Ostfold Hosp, Kalnes, Norway

[23] Innlandet Hosp, Lillehammer, Norway

[24] Innlandet Hosp, Gjovik, Norway

[25] Baerum Hosp, Vestre Viken, Gjettum, Norway

[26] Drammen Hosp, Vestre Viken, Drammen, Norway

[27] Vestfold Hosp, Tonsberg, Norway

[28] Telemark Hosp, Skien, Norway

[29] Sorlandet Hosp, Kristiansand, Norway

[30] Forde Hosp, Forde, Norway

[31] Alesund Hosp, Alesund, Norway

[32] Levanger Hosp, Levanger, Norway

[33] Nordlandssykehuset, Bodo, Norway

[34] Univ Hosp Northern Norway, Tromso, Norway

来源：

INFECTIOUS DISEASES | 2019年 / 51卷 / 06期

关键词：

Candidemia; risk factors; elderly; targeted treatment; 30-day mortality; ESCMID-ASTERISK GUIDELINE; INTERNAL-MEDICINE WARDS; INVASIVE CANDIDIASIS; SPECIES DISTRIBUTION; ANTIFUNGAL THERAPY; SEPTIC SHOCK; EPIDEMIOLOGY; INFECTIONS; MANAGEMENT; CARE;

D O I：

10.1080/23744235.2019.1595709

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background: In Norway, the epidemiological situation of candidemia is followed closely. We have previously demonstrated the highest incidence of candidemia in elderly >65years of age. However, knowledge of other aspects of this infection is lacking.Objective: The aim of this nationwide, retrospective study was to examine risk factors, therapeutic practice and outcome in adult candidemia patients according to age.Methods: We retrieved data from medical records from patients who developed candidemia in Norway between 1 January 2008 and 31 December 2012. Data were analyzed according to age, younger patients being between 18 and 65 years, elderly being 65 years of age.Results: From 771 eligible patients, 738 patients (95.7%) were included (58% men, mean age 65.2years, 58.1% being 65years). Exposure to health-care related risk factors for candidemia were significantly more common in the younger patients (neutropenia, central venous catheter, mechanical ventilation and chemotherapy) who received empirical treatment more often than the elderly (29.8% vs. 21.7%, p=.01). More elderly did not received any antifungal therapy (27.3% vs 16.8%, p<0001) and had higher mortality compared to younger patients (45.5% vs 23.9%, p<.0001). In the study population, mortality was higher with age (per 10-years increase, OR 1.43;1.28-1.59, p<0.0001), in patients not receiving targeted therapy (OR 2.5; CI 1.82-3.36, p<.0001) or any therapy at all (OR 4.64; 3.23-6.68, p<.0001).Conclusions: Risk factors for candidemia, treatment and outcome differed significantly according to age. Given the increasing numbers of elderly, scrutiny on our clinical practice is warranted.

引用

页码：425 / 434

页数：10

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