94例念珠菌血流感染患者的临床特点及死亡危险因素分析

中国真菌学杂志　 2023, Vol. 18 　Issue (2): 130-134.

94例念珠菌血流感染患者的临床特点及死亡危险因素分析

周婷婷, 覃仁利, 徐秋红, 罗柳春

柳州市人民医院, 柳州市病毒性疾病精准医学重点实验室, 柳州 545006

收稿日期:2022-04-24 出版日期:2023-04-28 发布日期:2023-05-26
通讯作者: 罗柳春,E-mail:344150580@qq.com E-mail:344150580@qq.com
作者简介:周婷婷,女(壮族),本科,副主任技师.E-mail:515662852@qq.com
基金资助:
广西壮族自治区卫生健康委员会重点实验室项目(ZZH2020004;GXHCFM2021004)

Clinical characteristics and risk factors for mortality of 94 patients with Candida bloodstream infection

ZHOU Tingting, QIN Renli, XU Qiuhong, LUO Liuchun

Liuzhou People's Hospital, Liuzhou Key Laboratory of Precision Medicine for Viral Diseases, Liuzhou 545006, China

Received:2022-04-24 Online:2023-04-28 Published:2023-05-26

摘要/Abstract

摘要： 目的探讨94例念珠菌血流感染患者的临床分布特点及发生死亡的相关危险因素。方法回顾性分析柳州市人民医院2019年1月—2021年12月确诊为念珠菌血流感染患者的临床特征及其发生死亡危险因素。结果 2019年—2021年血流感染患者共检出 94例念珠菌,主要分布于ICU和外科,占58.5%;排在前三位的念珠菌分别是白念珠菌、热带念珠菌、近平滑念珠菌,分别占48.9%、16.0%、13.8%;94例念珠菌血流感染患者中死亡33例,死亡率为35.1%;死亡患者中检出最高的为白念珠菌(57.6%,19/33),主要分布于ICU(57.6%,19/33);药敏结果显示,近平滑念珠菌对唑类抗真菌药敏感率为100%,白念珠菌对三唑类药物耐药率<7%,光滑念珠菌及热带念珠菌对其耐药率为20%~26.7%;单因素分析显示年龄≥60岁、基础疾病≥2种、机械通气、气管插管与死亡率有关(P<0.05),logistic二元回归分析结果提示机械通气是与念珠菌血流感染患者死亡率相关的独立危险因素。结论白念珠菌在念珠菌血流感染中检出率最高,机械通气是念珠菌血流感染患者发生死亡的独立危险因素。

关键词: 念珠菌, 血流感染, 临床特点, 死亡危险因素, 机械通气

Abstract: Objective To investigate the clinical distribution of 94 patients with blood flow infection of Candida and the related risk factors of death. Methods The clinical characteristics and death risk factors of patients with blood flow infection of Candida diagnosed in Liuzhou People's Hospital from January 2019 to December 2021 were analyzed retrospectively. Results From 2019 to 2021, 94 cases of Candida were detected in blood flow infection patients, mainly distributed in ICU and surgery, accounting for 58.5%; The top three Candida species were C. albicans, C. tropicalis and C. parapsilosis, accounting for 48.9%, 16.0% and 13.8% respectively;33 of 94 patients with blood flow infection of Candida died, the mortality rate was 35.1%. C. albicans (57.6%, 19/33) was most frequently detected in the dead patients, mainly distributed in ICU (57.6%, 19/33). The sensitivity rate of C. parapsilosis to azoles was 100%, the resistance rate of C. albicans to triazoles was less than 7% and the resistance rate of C. glabrata and C. tropicalis was 20%~26.7%. Univariate analysis showed that age ≥60 years, ≥2 basic diseases, mechanical ventilation and endotracheal intubation were associated with mortality (P<0.05). Logistic binary regression analysis showed that mechanical ventilation was an independent risk factor associated with mortality in patients with Candidal blood flow infection. Conclusion The detection rate of C. albicans in Candidal blood flow infection was the highest. Mechanical ventilation was an independent risk factor for death in patients with blood flow infection of Candida.

Key words: Candida, bloodstream infection, clinical characteristics, risk factors for mortality, mechanical ventilation

中图分类号:

R519.3

周婷婷, 覃仁利, 徐秋红, 罗柳春. 94例念珠菌血流感染患者的临床特点及死亡危险因素分析[J]. 中国真菌学杂志, 2023, 18(2): 130-134.

ZHOU Tingting, QIN Renli, XU Qiuhong, LUO Liuchun. Clinical characteristics and risk factors for mortality of 94 patients with Candida bloodstream infection[J]. Chinese Journal of Mycology, 2023, 18(2): 130-134.

参考文献

[1] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[2] MATOS T, LEJKO ZUPANC T, SKOFIJANEC A, et al. Candidaemia in Central Slovenia:A 12-year retrospective survey[J]. Mycoses,2021,64(7):753-762.
[3] PAPPAS P G, LIONAKIS M S, ARENDRUP M C, et al. Invasive candidiasis[J]. Nat Rev Dis Primers,2018,4:18026. DOI:10.1038/nrdp.2018.26.
[4] XIAO M, SUN Z Y, KANG M, et al. Five-year national surveillance of invasive candidiasis:species distribution and azole susceptibility from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study[J]. J Clin Microbiol,2018,56(7):e00577-18.
[5] 俞娟芬,张亚峰,张建国,等.真菌血流感染病原学与临床特点及其预后危险因素[J].中华医院感染学杂志,2022,32(6):852-856.
[6] 井然,侯欣,肖盟,等.中国侵袭性真菌耐药监测网成员单位重症监护室侵袭性酵母的布特征及其对三唑类药物敏感性的变迁[J].中国感染与化疗杂志,2020,20(2):175-180.
[7] PFALLER M A, DIEKEMA D J, TURNIDG J D, et al. Twenty years of the SENTRY antifungal surveillance program:Results for Candida species from 1997-2016[J]. Open Forum Infect Dis, 2019,6(Suppl 1):S79-S94.
[8] 刘云,黄晓春,万玉香,等.临床真菌血流感染的菌株分布及耐药性分析[J].现代检验医学杂志,2018,33(04):81-82,86.
[9] 陈霞,杨勇文,李艳明,等.ICU念珠菌血流感染患者的临床特点及死亡的危险因素[J].中南大学学报(医学版),2021,46(7):719-724.
[10] 黄廷廷,夏文颖,许雨乔,等.真菌血流感染患者死亡率相关危险因素分析[J].中国感染与化疗杂志,2020,20(5):465-469.
[11] 张文,罗莹,国承杰,等.院内念珠菌血症临床特点及病原菌分析[J].中国真菌学杂志,2020,15(3):154-160.
[12] SCHROEDER M, WEBER T, DENKER T, et al. Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany:a single-center retrospective 10-year analysis[J]. Ann Intensive Care,2020,10(1):142.
[13] 朱玲.念珠菌血流感染流行病学特征及病死率危险因素分析[D].上海交通大学,2016.
[14] MUDERRIS T, KAYA S, ORMEN B, et al. Mortality and risk factor analysis for Candida blood stream infection:A three-year retrospective study[J]. J Mycol Med,2020,30(3):101008.
[15] KATO H, YOSHIMURA Y, SUIDO Y, S et al. Mortality and risk factor analysis for Candida blood stream infection:A multicenter study[J]. J Infect Chemother,2019,25(5):341-345.