Invasive candidosis: contrasting the perceptions of infectious disease physicians and intensive care physicians

Introduction We analyze how infectious disease physicians perceive and manage invasive candidosis in Brazil, in comparison to intensive care unit specialists. Methods A 38-question survey was administered to 56 participants. Questions involved clinicians' perceptions of the epidemiology, diagnosis, treatment and prophylaxis of invasive candidosis. P < 0.05 was considered statistically significant. Results The perception that candidemia not caused by Candida albicans occurs in less than 10% of patients is more commonly held by intensive care unit specialists (p=0.018). Infectious disease physicians almost always use antifungal drugs in the treatment of patients with candidemia, and antifungal drugs are not as frequently prescribed by intensive care unit specialists (p=0.006). Infectious disease physicians often do not use voriconazole when a patient's antifungal treatment has failed with fluconazole, which also differs from the behavior of intensive care unit specialists (p=0.019). Many intensive care unit specialists use fluconazole to treat candidemia in neutropenic patients previously exposed to fluconazole, in contrast to infectious disease physicians (p=0.024). Infectious disease physicians prefer echinocandins as a first choice in the treatment of unstable neutropenic patients more frequently than intensive care unit specialists (p=0.013). When candidemia is diagnosed, most infectious disease physicians perform fundoscopy (p=0.015), whereas intensive care unit specialists usually perform echocardiograms on all patients (p=0.054). Conclusions This study reveals a need to better educate physicians in Brazil regarding invasive candidosis. The appropriate management of this disease depends on more drug options being available in our country in addition to global coverage in private and public hospitals, thereby improving health care.

引言 本研究对比分析巴西感染病科医师与重症监护病房（intensive care unit, ICU）专科医师对侵袭性念珠菌病（invasive candidosis）的认知与诊疗实践。
方法 本研究面向56名受试者开展了一项包含38个问题的问卷调查。问卷内容涵盖临床医师对侵袭性念珠菌病的流行病学、诊断、治疗及预防的认知情况。本研究将P<0.05判定为具有统计学显著性差异。
结果 重症监护病房专科医师更普遍认为，非白念珠菌（Candida albicans）所致念珠菌血症（candidemia）的患者占比不足10%（P=0.018）。感染病科医师几乎会全程对念珠菌血症患者使用抗真菌药物，而重症监护病房专科医师开具抗真菌药物的频率相对更低（P=0.006）。当患者经氟康唑（fluconazole）抗真菌治疗失败后，感染病科医师通常不会选用伏立康唑（voriconazole），这与重症监护病房专科医师的诊疗习惯存在显著差异（P=0.019）。对于既往接受过氟康唑治疗的中性粒细胞减少症念珠菌血症患者，许多重症监护病房专科医师仍会选用氟康唑进行治疗，这与感染病科医师的选择相悖（P=0.024）。相较于重症监护病房专科医师，感染病科医师更倾向于将棘白菌素类（echinocandins）药物作为病情不稳定的中性粒细胞减少症患者的一线治疗方案（P=0.013）。确诊念珠菌血症后，多数感染病科医师会为患者实施眼底检查（fundoscopy）（P=0.015）；而重症监护病房专科医师通常会为所有患者完成超声心动图检查（echocardiograms）（P=0.054）。
结论 本研究表明，巴西临床医师亟需接受针对侵袭性念珠菌病的系统化教育培训。要实现该病的规范化诊疗，需在本国公立与私立医疗机构保障现有抗真菌药物可及性的基础上，进一步扩充可供选择的治疗药物品类，以此提升医疗服务质量。