心血管导管相关念珠菌血症菌种分布、药物敏感性及患者预后情况的分析

中国真菌学杂志　 2020, Vol. 15 　Issue (1): 37-42.

心血管导管相关念珠菌血症菌种分布、药物敏感性及患者预后情况的分析

刘玉磊¹, 刘美清¹, 王丽¹, 袁慧¹, 郭莉娜²

1. 首都医科大学附属北京安贞医院, 北京 100029;
2. 中国医学科学院北京协和医院检验科侵袭性真菌病机制研究与精准诊断北京市重点实验室(BZ0447), 北京 100730

收稿日期:2019-05-20 出版日期:2020-02-28 发布日期:2020-02-28
通讯作者: 袁慧,E-mail:18911662931@189.cn E-mail:18911662931@189.cn
作者简介:刘玉磊,男(汉族),硕士,主管检验师.E-mail:lyulei@163.com
基金资助:
首都卫生发展科研专项（首发2016-1-4013）；国家自然科学基金（81770353）

Epidemiology, antifungal drugs susceptibilities and prognosis of catheter-related candidemia in cardiovascular disease patients

LIU Yu-lei¹, LIU Mei-qing¹, WANG Li¹, YUAN Hui¹, GUO Li-na²

1. Capital Medical University affiliated BeijingAnzhen Hospital, Beijing 100029, China;
2. Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases(BZ0447), Beijing 100730, China

Received:2019-05-20 Online:2020-02-28 Published:2020-02-28

摘要/Abstract

摘要：

目的阐明心血管疾病患者血管内导管相关真菌血症的流行病学资料及对患者预后的影响。方法收集安贞医院2012~2017年导管相关真菌血症患者实验室及临床资料，对病原学菌种分布、抗真菌药物敏感性、抗真菌治疗方案及预后数据进行统计分析。结果在纳入的71例研究对象中共有27例导管相关真菌血症患者，老年患者占51.9%。白假丝酵母菌占全部分离株的48.1%。分离株对临床常用抗真菌药物敏感率均在90%以上。与无菌血症组患者组相比，导管相关真菌血症患者具有更高的死亡率（P=0.024，Fisher精确检验）、更低的生活能力评分（P=0.00）、更长的住院时间（P=0.00）、更长的ICU留住天数（P=0.00）、更长的呼吸机依赖和更低的痊愈或好转出院率（P=0.02）。结论导管相关真菌血症以老年患者为主，体表或体内定植酵母菌可能是感染主要来源，临床常用抗真菌药物敏感率高。导管相关真菌血症会显著影响患者预后和加重医疗负担，应采取合理的院内感染防控措施防止导管相关真菌血症的发生。

关键词: 导管相关真菌血症, 菌种分布, 药敏试验, 预后

Abstract:

Objective To analyze the pathogenic epidemiological data of intravascular catheter-associated candidemia and the prognosis of patients. Methods Laboratory and clinical data of patients with catheter-related candidemia in AnZhen hospital from 2012 to 2017 were collected, and statistical analysis was conducted on the distribution of pathogenic bacteria, sensitivity of antifungal drugs, antifungal treatment and prognosis data. Results 71 subjects were included. A total of 27 patients with catheter-related candidemia were diagnosed, 51.9%(14) of which were elderly patients. Candida albicans accounted for 48.1%(13)of all the isolates. The susceptibility rate of all isolates to antifungal drugs that commonly used on clinic was above 90%. Compared with patients that undergo no bloodstream infection,patients with catheter-related candidemia have much more decline on Barthel index(-27.8 vs -13.5, P=0.00),longer length of hospitalization stay(40.0 days vs 12.8, P=0.00),longer length of ICU stay(14.4 days vs 2.3, P=0.00),much more hours of respirator support(318.4 vs 25.9, P=0.00), and less proportion of recovery or improvement(P=0.02,Fisher's Exact Test). Conclusion Catheter-associated candidemia is mainly occur in elderly patients. Candida albicans take the most place of the pathogenic isolates. Yeast colonize on the skin or in vivo may be the main source of infection. Catheter-related candidemia can significantly affect the prognosis of patients and aggravate the burden of medical care. Reasonable preventive measures should be taken to prevent the occurrence of catheter-related candidemia.

Key words: catheter-related candidemia, species distribution, drug susceptibility, prognosis

中图分类号:

R519.3

刘玉磊, 刘美清, 王丽, 袁慧, 郭莉娜. 心血管导管相关念珠菌血症菌种分布、药物敏感性及患者预后情况的分析[J]. 中国真菌学杂志, 2020, 15(1): 37-42.

LIU Yu-lei, LIU Mei-qing, WANG Li, YUAN Hui, GUO Li-na. Epidemiology, antifungal drugs susceptibilities and prognosis of catheter-related candidemia in cardiovascular disease patients[J]. Chinese Journal of Mycology, 2020, 15(1): 37-42.

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