ICU院内真菌性尿路感染临床特点及危险因素分析

中国真菌学杂志　 2022, Vol. 17 　Issue (4): 273-277.

ICU院内真菌性尿路感染临床特点及危险因素分析

朱俊峰, 周子阳, 胡万超, 唐建国

复旦大学附属上海市第五人民医院重症医学科, 上海 200240

收稿日期:2021-06-22 出版日期:2022-08-28 发布日期:2022-08-31
通讯作者: 唐建国,E-mail:tangjianguo@5thhospital.com E-mail:tangjianguo@5thhospital.com
作者简介:朱俊峰,男(汉族),硕士,住院医师.E-mail:1194953108@qq.com

Analysis of clinical characteristics and risk factors of nosocomial fungal urinary tract infection in ICU

ZHU Junfeng, ZHOU Ziyang, HU Wangchao, TANG Jianguo

Department of intensive care unit, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, China

Received:2021-06-22 Online:2022-08-28 Published:2022-08-31

摘要/Abstract

摘要： 目的探讨ICU院内真菌性尿路感染临床特点和危险因素。方法回顾性分析复旦大学附属上海市第五人民医院2016年1月至2020年12月期间ICU院内真菌性尿路感染患者临床资料，描述其临床特点、危险因素。结果 ①2016年-2020年收入复旦大学附属上海市第五人民医院重症监护室患者共2 557例，符合研究条件的共130例，真菌性尿路感染发生率为5.1%。②ICU院内真菌性尿路感染临床表现不典型，其发生与性别、年龄、导尿管留置时间有关，与年份无关。③尿病原体培养以白念珠菌为主（42.5%），其次为光滑念珠菌（31.3%），热带念珠菌（19.4%），近平滑念珠菌（4.5%），其他念珠菌（2.2%）。④对ICU院内真菌性尿路感染危险因素分析，单因素分析发现糖尿病、原发疾病脑卒中、抗生素种类、感染前血白细胞计数，感染前灌肠5个因素具有统计学意义（P<0.05）。将单因素分析有意义的指标纳入多因素分析中，结果提示糖尿病（P<0.001，OR=5.488）、原发疾病脑卒中（P=0.009，OR=2.782）、感染前血白细胞计数（P=0.014，OR=3.515）、感染前灌肠（P=0.001，OR=3.567）是ICU院内真菌性尿路感染发生的独立危险因素。结论针对ICU院内真菌性尿路感染，我们应采取积极措施治疗原发疾病及基础疾病，同时应警惕灌肠后所致的肠源性污染。

关键词: 真菌, 尿路感染, 危险因素

Abstract: Objective To investigate the clinical characteristics and risk factors of nosocomial fungal urinary tract infection in ICU. Methods The clinical data of patients with fungal urinary tract infection in the ICU of Shanghai Fifth People's Hospital affiliated to Fudan University from January 2016 to December 2020 were retrospectively analyzed, and the clinical characteristics and risk factors of the patients were described. Results ①From 2016 to 2020, a total of 2557 patients were enrolled in the intensive care unit of Shanghai Fifth People's Hospital Affiliated to Fudan University, and 130 patients met the research conditions. The incidence of fungal urinary tract infection was 5.1%. ②The clinical manifestations of nosocomial fungal urinary tract infection in ICU were atypical, and its occurrence was related to gender, age, and catheter indwelling time, but not to the year.③In the urine culture, Candida albicans was the main pathogen, accounting for 42.5%, followed by Candida glabra (31.3%), Candida tropicalis (19.4), Candida parapsilosis (4.5%), and other Candida (2.2%).④The risk factors of nosocomial fungal urinary tract infection in ICU were analyzed. Univariate analysis showed that diabetes, primary disease stroke, antibiotics, preinfection white blood cell count and preinfection enema had statistical significance (P<0.05).The significant indicators from univariate analysis were incorporated into the multivariate analysis. The Results showed that diabetes mellitus (P<0.001,OR=5.488), primary disease stroke (P=0.009,OR=2.782), preinfection white blood cell count (P=0.014,OR=3.515) and preinfection enema (P=0.001,OR=3.567) were independent risk factors for nosocomial fungal urinary tract infection in ICU. Conclusion For the nosocomial fungal urinary tract infection in ICU, we should take active measures to treat the primary disease and the basic disease, and at the same time, we should be alert to the enterogenous pollution caused by enema.

Key words: fungi, urinary tract infection, risk factor

中图分类号:

R519.3

朱俊峰, 周子阳, 胡万超, 唐建国. ICU院内真菌性尿路感染临床特点及危险因素分析[J]. 中国真菌学杂志, 2022, 17(4): 273-277.

ZHU Junfeng, ZHOU Ziyang, HU Wangchao, TANG Jianguo. Analysis of clinical characteristics and risk factors of nosocomial fungal urinary tract infection in ICU[J]. Chinese Journal of Mycology, 2022, 17(4): 273-277.

参考文献

[1] HSIAO C, YANG H, ChANG C, et al.Risk factors for development of septic shock in patients with urinary tract infection[J].Biomed Res Int, 2015, 2015:717094.DOI:10.1155/2015/717094.
[2] GRAY M.Reducing catheter-associated urinary tract infection in the critical care unit[J].AACN Adv Crit Care, 2010, 21(3):247-257.
[3] CHU C M, LOWDER J L.Diagnosis and treatment of urinary tract infections across age groups[J].Am J Obstet Gynecol, 2018, 219(1):40-51.
[4] BURTON D C, EDWARDS J R, SRINIVASAN A, et al.Trends in catheter-associated urinary tract infections in adult intensive care units-United States, 1990-2007[J].Infect Control Hosp Epidemiol, 2011, 32(8):748-756.
[5] ROSENTHAL V D, MAKI D G, JAMULITRAT S, et al.International nosocomial infection Control consortium (INICC) report, data summary for 2003-2008, issued June 2009[J].Am J Infect Control, 2010, 38(2):95-104.
[6] 杨爱祥, 杨静, 郑贞苍, 等.ICU院内尿路真菌感染临床分析[J].中华医院感染学杂志, 2012, 22(23):5416-5418.
[7] 易玲娴.综合ICU尿路真菌感染临床特点[J].解放军医学院学报, 2014, 35(1):68-69.
[8] PASSOS X S, SALES W S, MACIEL P J, et al.Candida colonization in intensive care unit patients' urine[J].Mem Inst Oswaldo Cruz, 2005, 100(8):925-928.
[9] 蒋多云.真菌性尿路感染的调查研究及危险因素分析[D].广西医科大学, 2016.
[10] ODABASI Z, MERT A.Candida urinary tract infections in adults[J].World J Urol, 2020, 38(11):2699-2707.
[11] 干超士, 左红霞.急性脑卒中患者真菌性尿路感染的易感因素分析[J].现代实用医学, 2010, 22(1):56-57.
[12] JAIN M, DOGRA V, MISHRA B, et al.Candiduria in catheterized intensive care unit patients:emerging microbiological trends[J].Indian J Pathol Microbiol, 2011, 54(3):552-555.
[13] MAGRUDER M, SHOLI A N, GONG C, et al.Gut uropathogen abundance is a risk factor for development of bacteriuria and urinary tract infection[J].Nat Commun, 2019, 10(1):5521.

[1]	周成龙, 徐蒙, 张海平, 孙妍, 郑渊, 张晓利. 331例头癣临床流行病学特征分析[J]. 中国真菌学杂志, 2022, 17(5): 373-376.
[2]	胡爱玲, 衡媛, 赵旭初, 王东, 佟钊, 杜雅丽, 赵云旺, 王娜. 医院念珠菌尿路感染菌株分布及耐药性分析[J]. 中国真菌学杂志, 2022, 17(5): 380-384.
[3]	董小平, 陈欢, 刘海波, 刘芳, 段奇峰, 桑红. 南京地区734例甲真菌病临床及致病菌分析[J]. 中国真菌学杂志, 2022, 17(5): 391-393.
[4]	王晓娟, 秦玉璘, 沈春英, 杨其莲, 喻轶群, 曹永兵, 韩冰. 他汀类药物治疗真菌感染研究进展[J]. 中国真菌学杂志, 2022, 17(5): 408-413.
[5]	张苗苗, 崔滋欣, 王晓鹏, 牛新武, 朱艳艳, 耿松梅, 刘成程. 光动力疗法治疗甲真菌病的临床研究进展[J]. 中国真菌学杂志, 2022, 17(5): 421-424.
[6]	吴雨娴, 张旺喆麒, 徐洋, 柴晓云. 基于抗真菌药物的近红外荧光探针研究进展[J]. 中国真菌学杂志, 2022, 17(5): 431-434.
[7]	巢雯, 邓忠宇, 郭士槿, 郭熠凡, 阎澜, 邱丽娟, 吕权真. 小G蛋白抑制剂CASIN的体外抗真菌活性研究[J]. 中国真菌学杂志, 2022, 17(4): 289-293.
[8]	刘佳存, 王瑞娜, 吕权真, 阎澜. 白念珠菌耐药机制研究进展[J]. 中国真菌学杂志, 2022, 17(4): 319-323.
[9]	魏天琦, 刘沐桑. 蛋白质组学在真菌生物膜中的应用研究进展[J]. 中国真菌学杂志, 2022, 17(4): 324-329.
[10]	杨之辉, 李若瑜. 浅部真菌感染中的抗真菌药物治疗进展[J]. 中国真菌学杂志, 2022, 17(4): 339-348.
[11]	孟玲宁, 曹小利, 张燕, 周万青, 沈瀚. 真菌细胞外囊泡的研究进展[J]. 中国真菌学杂志, 2022, 17(4): 349-352.
[12]	王静, 尹瑞瑞, 张芙蓉, 陈萍, 杨国玲. 24例儿童脓癣临床分析[J]. 中国真菌学杂志, 2022, 17(3): 195-199.
[13]	唐人杰, 王瑞娜, 王旭, 汪洋, 李志勇, 刘佳存, 吴林, 张大志, 阎澜. 某院校学员浅部真菌病影响因素分析[J]. 中国真菌学杂志, 2022, 17(3): 205-212.
[14]	杜昱聪, 刘环海. 盐酸特比萘芬乳膏联合3%硼酸酒精滴耳液治疗真菌性外耳道炎的效果[J]. 中国真菌学杂志, 2022, 17(3): 227-230.
[15]	高路, 吕权真, 甄诚, 阎澜, 姜远英. 化学基因组学在抗真菌药物研究中的应用[J]. 中国真菌学杂志, 2022, 17(3): 235-240.