侵袭性真菌感染的早期治疗PPT课件.pptx

侵袭性真菌感染的早期治疗

华中科技大学附属协和医院

付朝晖

一项临床研究带给我们的思考

Amulticentrestudytoevaluatetheimpactoftimingofcaspofungin

administrationonoutcomesofinvasivecandidiasis

innon-immunocompromisedadultpatients

DonaldI.Hsu¹,2*,MeganNguyen¹,LeeNguyen³,AnandiLaw¹andAnnieWong-Beringer

WesternUniversityCollegeofPharmacy

JAntimicrobChemother2010:65:1765-1770

■多中心回顾性队列研究2004.1-2007.12

■研究人群：诊断为侵袭性念珠菌感染并接受卡泊芬净治疗3天的患者，分为早期治疗组(标本送检3天内开始治疗)和延迟治疗组(标本送检3天后开始治疗)

■评价终点：1.取得病情稳定的时间

2.治疗反应

3.住院时间

4.分离病原菌后住院时间

5.死亡率和感染相关死亡率

对非免疫缺陷成人患者侵袭性念珠菌病治疗时机的多中心研究

Age(years)

mean±SD

median,IQR

Residence

community

nosocomial

APACHEIⅡ

mean±SD

median,IQR

Numberofco-morbidconditions

mean±SD

median,IQR

cerebrovascularaccident

lungdisease

diabetesmellitus

congestiveheartfailure

coronaryarterydisease

liverdisease

renaldisease

Infectionsites

blood

intra-abdominal

other

InfectingCandidaspecies

mixed

C.albicans

C.parapsilosis

C.tropicalis

C.glabrata

C.krusei

others

患者基线特点比较

VariablesEI,n=107DI,n=62Pvalue

65.0(16.9)

64(55-77)

55(51.4%)52(48.6%)

18.7(7.6)18(13-23)

3.3(2.1)

3(2-5)

24(22.4%)

27(25.2%)

37(35.6%)

15(14.0%)

42(39.3%)

7(6.5%)

28(26.2%)

79(73.8%)

26(24.3%)

2(1.9%)

22(20.5%)

27(25.2%)

7(6.5%)

3(2.8%)

47(43.9%)0

1(1.0%)

57.7(17.9)58(49-73)

36(58.1%)26(41.9%)

17.6(7.2)17(12-22)

3.2(2.1)

3(1.8-5)15(25.8%)7(11.3%)20(32.3%)6(9.7%)20(32.3%)9(14.5%)13(21.0%)

40(64.5%)

18(29.0%)

4(6.5%)

14(22.6%)

9(14.5%)

2(3.2%)

3(4.8%)

31(50.0%)

2(3.2%)

1(1.6%)

0.009

0.40

0.36

0.69

0.920.0290.760.410.360.0880.45

0.20

0.50

0.19

0.76

0.10

0.36

0.67

0.45

0.13

1.00

结果一：患者预后

Table2.ComparisonofoutcomevariablesbetweenEIandDIofcaspofungintherapy

Variables

EI,n=107

DI,n=62

Pvalue

Overallresponse

82(76.6%)

35(56.5%)

0.006

All-causemortality

24(22.4%)

19(30.6%)

0.27

Infection-relatedmortality

21(19.6%)

18(29.0%)

0.16

Totallengthofstay,days

mean±SD

33.30(40.016)

39.35(23.08