新型冠状病毒共感染耳念珠菌患者临床结局评价  

Clinical treatment outcomes of patients with concurrent infections of SARS-CoV-2 and Candida auris

作　　者：郝萌萌 郭丽萍[1,2] 黄记水 邢京宇 刘明艳 蒋艳 HAO Meng-meng;GUO Li-ping;HUANG Ji-shui;XING Jing-yu;LIU Ming-yan;JIANG Yan(China-Japan Friendship Hospital,Beijing 100029,China;不详)

机构地区：[1]中日友好医院医院感染管理办公室,北京100029 [2]北京中医药大学管理学院,北京100029 [3]南安市医院呼吸与危重症医学科,福建泉州362399

出　　处：《中华医院感染学杂志》2025年第2期207-214,共8页Chinese Journal of Nosocomiology

基　　金：中央高水平医院临床业务费专项基金资助项目(2023-NHLHCRF-YXHZ-ZRZD-02)。

摘　　要：目的以全因死亡率(以下简称病死率)系统评价抗真菌药物治疗新型冠状病毒与耳念珠菌共感染患者的临床结局。方法系统检索2019年12月—2023年12月Pubmed、Web of Science、中国知网、万方数据知识平台、维普网和中国生物中英文医学文献数据库治疗新型冠状病毒与耳念珠菌共感染患者相关的文献,使用Stata14.0软件完成Meta分析。结果研究最终纳入9篇文献,其中44例患者接受了抗真菌药物治疗,治疗药物包括棘白菌素类、多烯类和第二代三唑类药物。Meta分析结果显示:接受抗耳念珠菌治疗的共感染患者病死率为62.82%[95%CI(43.86%~80.43%)];进一步进行亚组分析:患者为女性、年龄大(≥71岁)、自身基础疾病多(2种及以上)、接受的侵入性操作多(3种)病死率均为同一亚组内最高;同时有血流感染和其他部位感染的患者病死率高于仅有血流感染或其他部位感染的患者;糖皮质激素和抗菌药物共用使用的情况下患者病死率高。应用不同类别抗真菌药物治疗时,多烯类药物单用病死率(0.00%)<棘白菌素类+三唑类药物联用(39.22%)<棘白菌素类+多烯类药物联用(62.44%)<棘白菌素类药物单用(68.29%)<棘白菌素+多烯类+三唑类药物联用(100.00%)。结论同时使用糖皮质激素和抗菌药物的共感染患者病死率高,棘白菌素类联合三唑类或多烯类药物是新型冠状病毒与耳念珠菌共感染患者首选的抗耳念珠菌治疗方案。OBJECTIVE To evaluate the clinical treatment outcomes of the patients with concurrent infections of SARS-CoV-2 and Candida auris who were treated with antifungal drugs based on all-cause mortality(hereinafter referred to as mortality).METHODS The literatures regarding to the treatment of concurrent infections of SARS-CoV-2 and C.auris were systematically retrieved from Pubmed,Web of Science,CNKI,Wanfang,VIP,and Chinese BioMedical Literature Database.Meta-analysis was performed by using Stata 14.0 software.RESULTS Totally 9 literatures were finally included in the study,involving 44 patients who received antifungal drug therapy;the therapeutic drugs included echinocandins,polyenes and second-generation triazoles.The result of Meta-analysis showed that the mortality rate of the concurrent infection patients who received anti-C.auris treatment was 62.82%[95%CI(43.86%to 80.43%)].The further subgroup analysis indicated that the mortality rates of the patients of female,no less than 71 years of age,no less than 2 types of autologous underlying diseases,and receiving 3 types of invasive procedures were the highest in the same subgroup.The mortality rate of the patients who had simultaneous bloodstream infection and other sites of infection was higher than that of the patients who had simple bloodstream infection or other sites of infection.The mortality rate of the patients who were simultaneously treated with glucocorticoids and antibiotics was high.The mortality rates of the patients who were treated with the different types of antifungal drugs were as follows:single use of polyenes(0.00%)<combined use of echinocandins and triazoles(39.22%)<combined use of echinocandins and polyenes(62.44%)<single use of echinocandins(68.29%)<combined use of echinocandins,polyenes and triazoles(100.00%).CONCLUSIONS The mortality rate of the concurrent infection patients who are simultaneously treated with glucocorticoids and antibiotics is high.Echinocandins combined with triazoles or polyenes is the preferred anti-C.auris treatment p

关 键 词：耳念珠菌 新型冠状病毒感染 共感染 抗真菌药物 治疗 META分析 

分 类 号：R379.4[医药卫生—病原生物学]