Invasive candidiasis in the elderly: a single-center, retrospective cohort study
10.3760/cma.j.issn.0254-9026.2022.01.010
- VernacularTitle:老年患者侵袭性念珠菌病特点和治疗研究
- Author:
Zhihui YANG
1
;
Yinggai SONG
;
Lianjun LIN
;
Ruoyu LI
;
Jin YU
Author Information
1. 北京大学第一医院皮肤性病科 北京大学真菌和真菌病研究中心 皮肤病分子诊断北京市重点实验室 国家皮肤与免疫疾病临床医学研究中心 国家药品监督管理局化妆品质量控制与评价重点实验室 100034
- Keywords:
Invasive candidiasis;
Risk factors;
Therapy;
Prognosis
- From:
Chinese Journal of Geriatrics
2022;41(1):44-50
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical and mycological characteristics, treatment and prognosis of invasive candidiasis(IC)in the elderly.Methods:This retrospective study included aged patients(≥65 years)admitted to the Peking University First Hospital between January, 2010 and December, 2019, who were diagnosed with IC based on positive culture results.The infecting strains were re-identified and their antifungal drug resistance was tested.The clinical and mycological characteristics, treatment and prognosis information of the elderly patients were collected and compared with those of non-elderly adults.Results:A total of 99 aged patients were included, with a median age of 78(70-83)years and a male-to-female ratio of 2.1∶1.0.The elderly accounted for 62.7%(99/158)of the adult IC patients.Compared with their younger counterparts, elderly patients were more likely to need medium-to long-term hospitalization and intensive care unit(ICU)stay, and to show concurrent heart failure, respiratory failure or renal failure, to require mechanical ventilation, and to show deep-seated bacterial infections and multifocal Candida colonization, especially for those with previous fluconazole exposure( P<0.05). Bloodstream was the most common Candida transmission route(71/99, 71.7%)and Candida albicans was the most prevalent species(47/99, 47.5%). Antifungal resistance was highest for fluconazole(17/117, 14.5%)and voriconazole(15/117, 12.8%). No significant difference was found between elderly patients and non-elderly patients in terms of infected sites, Candida species, and antifungal resistance( P>0.05). A total of 86 patients(86.9%)received systemic antifungal treatment and fluconazole was the most commonly used drug(35/86, 40.7%). The thirty-day all-cause mortality in aged IC patients was 32.6%(29/89), significantly higher than in younger patients( P=0.022). Logistic regression analysis revealed that advanced age( OR=1.12, 95% CI: 1.06-1.20, P<0.001), renal failure( OR=4.81; 95% CI: 1.65-14.03; P=0.004), and a high Candida score( OR=1.81, 95% CI: 1.06-3.11, P=0.031)significantly increased the risk of death. Conclusions:Elderly patients were the main affected population of IC, and the mortality of IC steadily increases with age.Treatment for aged IC patients should be proactive and cautious.
