関連する実験動画

Updated: Feb 5, 2026

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Published on: January 16, 2019

真菌血症対細菌血症における重症患者の集中治療介入の利用：多施設共同後ろ向きコホート研究

Mary North Jones^1,2, Masayuki Nigo^1,3,4, Stefano Casarin^5,6,7

¹Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX.

Critical care medicine

|February 3, 2026

Insights

集中治療室（ICU）資源を必要とする重症患者は、真菌血症、すなわち血液感染症のリスクが高い。これらのハイリスクICU患者には、経験的抗真菌療法が有益である可能性がある。

科学分野:

感染症
クリティカルケア医学

背景:

カンジダ種は、集中治療室（ICU）における血液感染症（BSI）の一般的な原因です。
現在のガイドラインでは、疑われるBSIを有するICU患者における経験的抗真菌療法の開始に関する強力な推奨事項が欠如しています。

研究の目的:

ICU発症真菌血症と細菌血症の患者の特性を比較すること。
これらの患者における死亡率のリスク因子を特定すること。
真菌血症がICU患者の死亡の独立したリスク因子であるかどうかを判断すること。

主な方法:

テキサス州ヒューストンの病院システムからのICU患者のBSIに関する後ろ向きコホート研究（2016-2023年）。
公開されているMedical Information Mart for Intensive Care（MIMIC）-IVコホートを使用した検証。
ICU介入およびベースラインパラメータを調整して、死亡率の独立したリスク因子としての真菌血症を評価するための多変量回帰分析。

主要な成果:

一次コホートの1509人の患者のうち、19.2%が真菌血症、80.8%が細菌血症でした。
真菌血症患者は、侵襲的人工換気、血管作動薬、および持続的腎代替療法の利用率が高いことを示しました。
真菌血症は一次コホートの死亡率とは独立して関連していませんでしたが、MIMIC-IVコホートでは関連していました。

結論:

高いICU資源利用率に直面している患者は、真菌血症のリスク増加に直面しています。
経験的抗生物質を開始する際に、高資源ケアを必要とするICU患者の経験的抗真菌療法の開始を検討することが示唆されています。

Read full analysis

要旨

Objectives:

Candida species are one of the most common causes of ICU-onset bloodstream infection (BSI). Yet, there is no robust guidance on when to initiate empiric antifungals for ICU patients suspected of BSI. We compared patients with ICU-onset candidemia vs. ICU-onset bacteremia to determine which patients may benefit from empiric antifungals.

Design:

We compared characteristics between patients with bacteremia vs. candidemia at time of culture. We determined risk factors for death and constructed a multivariable regression to determine if candidemia is an independent risk factor for death.

Setting/Patients:

We included ICU patients from a hospital system in Houston, Texas (n = 8 hospitals) with a BSI from 2016 to 2023 and validated our findings using ICU patients with a BSI in the publicly available Medical Information Mart for Intensive Care (MIMIC)-IV cohort.

Interventions:

None.

Measurements And Main Results:

Of 1509 total patients in our primary cohort, 290 (19.2%) had candidemia and 1219 (80.8%) had bacteremia. Patients with candidemia were more likely to be on invasive mechanical ventilation (72.8% vs. 52.8%; p < 0.001), vasopressors (39.3% vs. 24.0%; p < 0.001), and continuous renal replacement therapy (15.2% vs. 9.4%; p = 0.006) at the time of culture. They contracted infection later in ICU stay than bacteremia patients (7.2 vs. 5.0 d; p < 0.001) and were more likely to die within 30 days of culture (unadjusted odds ratio [OR], 1.62; 95% CI, 1.25-2.09). After adjusting for ICU interventions (invasive mechanical ventilation, vasopressors, and continuous renal replacement therapy) and baseline parameters, candidemia was not independently associated with mortality compared with bacteremia in our primary cohort (OR, 1.21; 95% CI, 0.92-1.60) but was in the MIMIC-IV cohort (OR, 1.48; 95% CI, 1.003-2.17).

Conclusions:

Patients with significant ICU resource utilization are at increased risk for candidemia. Our data suggest that when initiating empiric antibiotics in patients requiring high-resource ICU care, empiric antifungal therapy should be considered.

キーワード:

真菌血症重症患者腎代替療法血管作動薬人工換気

さらに関連する動画

Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients

Published on: April 12, 2011

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Endotoxin Activity Assay for the Detection of Whole Blood Endotoxemia in Critically Ill Patients

Published on: June 24, 2019

関連する概念動画

Patient-centered Care

Patient-centered Care

Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...

Nursing Interventions I: Taxonomy of Nursing Interventions

Nursing Interventions I: Taxonomy of Nursing Interventions

Nursing interventions are chosen as part of the planning process to achieve patient outcomes. Once nursing diagnoses are determined, the goals and outcomes are specified, then the nursing interventions are selected and individualized according to the patient's situation.
A nursing intervention is a treatment or action based on scientific concepts and knowledge from the nursing, behavioral, and physical sciences. Identifying and prioritizing nursing interventions based on the desired outcome...

Nursing Interventions II: Selecting and Classifying the Nursing Interventions

Nursing Interventions II: Selecting and Classifying the Nursing Interventions

Creating and executing a nursing diagnosis helps nurses plan care and guide patient, family, and community interventions. They are developed based on a patient's physical evaluation and support measuring the outcomes. It is not recommended to select random interventions throughout the planning process. Instead, consider the following six essential factors when choosing interventions:

Critical Region, Critical Values and Significance Level

Critical Region, Critical Values and Significance Level

The critical region, critical value, and significance level are interdependent concepts crucial in hypothesis testing.
In hypothesis testing, a sample statistic is converted to a test statistic using z, t, or chi-square distribution. A critical region is an area under the curve in probability distributions demarcated by the critical value. When the test statistic falls in this region, it suggests that the null hypothesis must be rejected. As this region contains all those values of the...

Varicose Veins II: Diagnostic Studies and Interprofessional Care

Varicose Veins II: Diagnostic Studies and Interprofessional Care

Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...