Terapevticheskii arkhiv

Терапевтический архив

0040-36602309-5342

LLC Obyedinennaya Redaktsiya

31787

Editorial article

Передовая статья

Research Article

Factors influencing recovery in patients with hemoblastoses and candidemia

Факторы, влияющие на излечение у больных гемобластозами и кандидемией

Klyasova

G A

Клясова

Г А

Blokhina

E V

Блохина

Е В

Gracheva

A N

Грачева

А Н

Kravchenko

S K

Кравченко

С К

Parovichnikova

E N

Паровичникова

Е Н

Okhmat

V A

Охмат

В А

Korobova

A G

Коробова

А Г

Galstyan

G M

Галстян

Г М

Kulikov

S M

Куликов

С М

«Гематологический научный центр» Минздрава России

15072015

877

VOL 87, NO7 ()

ТОМ 87, №7 (2015)

778710042020

2015

Consilium Medicum

ООО "Консилиум Медикум"

https://creativecommons.org/licenses/by-nc-sa/4.0

https://ter-arkhiv.ru/0040-3660/article/view/31787

Aim. To study the factors influencing the results of treatment for candidemia (CE) in patients with blood system tumors. Subjects and methods. The investigation enrolled patients with hemoblastoses and CE. 30-day all-cause mortality was analyzed. Results. In an 8-year period (2006—2013), CE was diagnosed in 55 patients (median age, 50 years); there was a preponderance of patients with lymphomas (47%) and acute leukemias (27%). The causative agents of CE were C. albicans (38%), С. parapsilosis (17%), С. krusei (11%), C. guilliermondii (11%), C. lusitaniae (6%), C. tropicalis (6%), С. glabrata (3%), С. famata (3%), C. pelliculosa (3%), and C. kefyr (2%). 30-day all-cause mortality was 43.6%. Recovery was statistically significantly more frequently seen following removal of a central venous catheter (67% versus 13%; p=0.004; odds ratio (OR), 14); after use of an antifungal drug on day 1 of isolation of Candida spp. from blood cultures (62% versus 13%; p=0.01; OR, 12); and that of echocandin as a first-line agent (86% versus 42%; p=0.005; OR, 8.4). The poor predictors were septic shock (5% recovery rate versus 86% in the patients without this factor; p<0.0001; OR, 0.01), granulocytopenia (42% versus 88%; p=0.001; OR, 0.1); use of amphotericin B as a first-line drug (26% versus 71%; p=0.002; OR, 0.15); hemoblastosis recurrence or resistance (39% versus 73%; p=0.01; OR, 0.24). Multivariate analysis showed the positive impact of antifungal administration on day 1 of isolation of Candida spp. from blood cultures on treatment results (p=0.03; OR, 27). Conclusion. High mortality rates were noted in the patients with hemoblastoses and CE. The recovery rates were statistically significantly higher after use of echinocandin as a first-line agent, after that of an antifungal agent on day 1 of positive blood cultures, after removal of a central venous catheter, and hemoblastosis remission.

Цель исследования. Изучить факторы, влияющие на результаты лечения кандидемии (КЕ) у больных с опухолями системы крови. Материалы и методы. В исследование включены пациенты с гемобластозами и КЕ. Общая летальность анализирована в течение 30 дней. Результаты. За 8-летний период (2006—2013 гг.) КЕ диагностировали у 55 больных (медиана возраста 50 лет), преобладали больные с лимфомами (47%) и острыми лейкозами (27%). Возбудителями КЕ были C. albicans (38%), С. parapsilosis (17%), С. krusei (11%), C. guilliermondii (11%), C. lusitaniae (6%), C. tropicalis (6%), С. glabrata (3%), С. famata (3%), C. pelliculosa (3%), C. kefyr (2%). Общая летальность при КЕ в течение 30 дней составила 43,6%. Излечение статистически значимо чаще наблюдалось в случае удаления центрального венозного катетера (67% против 13%; p=0,004; отношение шансов — ОШ 14), назначения противогрибкового препарата в 1-й день выделения Candida spp. из гемокультуры (62% против 13%; p=0,01; ОШ 12); использования эхинокандина в качестве препарата первого ряда (86% против 42%; р=0,005; ОШ 8,4;). Прогностически неблагоприятными факторами служили развитие септического шока (излечение у 5% больных против 86% без такового фактора; p<0,0001; ОШ 0,01 ), наличие гранулоцитопении (42% против 88%; p=0,001; ОШ 0,1), назначение амфотерицина В в качестве препарата первого ряда (26% против 71%; p=0,002; ОШ 0,15), рецидив или резистентность гемобластоза (39% против 73%; p=0,01; ОШ 0,24). При многофакторном анализе благоприятное воздействие на результаты лечения оказывало назначение антимикотика в 1-й день выделения Candida spp. из гемокультуры (р=0,03; ОШ 27). Заключение. Отмечена высокая летальность у больных гемобластозами и КЕ. Частота излечений статистически значимо выше при использовании эхинокандина в качестве препарата первого ряда, назначении антимикотика в 1-е сутки положительной гемокультуры, удалении центрального венозного катетера, наличии ремиссии гемобластоза.

candidemia treatmentechinocandinsamphotericin Bhemoblastoses

лечение кандидемииэхинокандиныамфотерицин Вгемобластозы

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