院内念珠菌血症临床特点及病原菌分析

摘要/Abstract

摘要：

目的探讨念珠菌血症患者的临床特点、病原种类、药敏试验及治疗预后。方法回顾性分析山东淄博市中心医院2011年1月至2018年12月期间住院念珠菌血症患者的临床资料，描述其危险因素、临床特点、念珠菌种类分布、药敏情况及治疗转归。结果住院念珠菌血症患者主要来源于ICU（35.9%），多为老年患者（>60岁，75.7%）。白念珠菌是最常见的分离菌株（40.8%），其次是热带念珠菌（20.4%）、近平滑念珠菌（20.4%）、光滑念珠菌（10.7%）和克柔念珠菌（3.9%）。2011年到2018年间，白念珠菌的分离率呈现先增高后降低的趋势，近年非白念菌株检出比例上升。念珠菌对唑类药物的耐药主要表现在热带念珠菌和光滑念珠菌，白念珠菌和近平滑念珠菌对唑类的敏感性亦呈现下降趋势。念珠菌血症患者30 d粗死亡率为39.8%，多因素回归分析显示高龄（OR=1.091，P=0.001）和糖尿病（OR=9.709，P=0.005）是独立危险因素，针对性抗真菌治疗（OR=0.142，P=0.008）可改善患者预后。结论对住院高危患者采取积极治疗基础疾病、减少侵入性操作等措施可减少念珠菌血症的发生，及时针对性应用抗真菌药物可改善患者预后。

关键词: 念珠菌血症, 危险因素, 药敏试验, 预后

Abstract:

Objective To explore clinical features, pathogen distribution, antifungal resistance and prognosis of patients with candidiamia. Methods The clinical data of inpatients with candidemia from January 2011 to December 2018 in Zibo Central Hospital were retrospectively studied, and the risk factors, clinical features, species distribution, drug sensitivity and clinical outcomes were described and analyzed. Results The inpatients with candidemia were mainly from ICU (35.9%), and most of them were elderly patients (>60 years old, 75.7%). Candida albicans (40.8%) were the primary species, followed by C. tropicalis (20.4%), C. parapsilosis (20.4%), C. glabrata (10.7%) and C. krusei (3.9%). The separation rate of C. albicans showed the tendency of firstly increased and then decreased from 2011 to 2018, and non-albicans candidemia had risen in recent years. Azole resistance mainly arised in C. tropicalis and C. glabrata, and the sensitivity of C. albicans and C. parapsilosis to azole also declined. The 30-day crude mortality rate was 39.8%. Multivariate regression analysis revealed that agedness (OR=1.091, =0.001) and diabetes (OR=9.709, P=0.005) were independent risk factors, and targeted antifungal therapy (OR=0.142, P=0.008) could improve the prognosis of patients. Conclusion The incidence of candidemia can be reduced by treating basic diseases and reducing invasive operations in high-risk hospitalized patients, and the prognosis of patients can be improved by timely and targeted application of antifungal drugs.

Key words: candidemia, risk factors, antifungal susceptibility test, prognosis

中图分类号:

R519.3

张文, 罗莹, 国承杰, 徐英春, 肖盟, 类承斌, 赵燕, 毕蕾. 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.

ZHANG Wen, LUO Ying, GUO Cheng-jie, XU Ying-chun, XIAO Meng, LEI Cheng-bin, ZHAO Yan, BI Lei. Clinical characteristics and pathogen of patients with candidemia[J]. Chinese Journal of Mycology, 2020, 15(3): 154-160.

参考文献

[1] Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study[J]. Clin Infect Dis, 2004, 39(3):309-317.
[2] Wang H, Xu YC, Hsueh PR. Epidemiology of candidemia and antifungal susceptibility in invasive Candida species in the Asia-Pacific region[J]. Future Microbiol, 2016, 11:1461-1477.
[3] Colombo AL, Nucci M, Park BJ, et al. Epidemiology of candidemia in Brazil:a nationwide sentinel surveillance of candidemia in eleven medical centers[J]. J Clin Microbiol, 2006, 44(8):2816-2823.
[4] Ma CF, Li FQ, Shi LN, et al. Surveillance study of species distribution, antifungal susceptibility and mortality of nosocomial candidemia in a tertiary care hospital in China[J]. BMC Infect Dis, 2013, 13:337.
[5] ClSI. Performance Standards for Antifungal Susceptibility Testing of Yeasts. 1st ed[S]. CLSI supplement M60 Wayne, PA:Clinical and Laboratory Standards Institut. 2017.
[6] Pfaller MA, Diekema DJ. Progress in antifungal susceptibility testing of Candida spp. by use of Clinical and Laboratory Standards Institute broth microdilution methods, 2010 to 2012[J]. J Clin Microbiol, 2012, 50(9):2846-2856.
[7] Tan BH, Chakrabarti A, Li RY, et al. Incidence and species distribution of candidaemia in Asia:a laboratory-based surveillance study[J]. Clin Microbiol Infect, 2015, 21(10):946-953.
[8] Guo F, Yang Y, Kang Y, et al. Invasive candidiasis in intensive care units in China:a multicentre prospective observational study[J]. J Antimicrob Chemother, 2013, 68(7):1660-1668.
[9] Wang H, Xiao M, Chen SC, et al. In vitro susceptibilities of yeast species to fluconazole and voriconazole as determined by the 2010 National China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study[J]. J Clin Microbiol, 2012, 50(12):3952-3959.
[10] 秦晓峰, 王英, 吴建华, 等. 院内深部念珠菌感染菌种分布和耐药性分析[J]. 中国真菌学杂志, 2016, 11(3):166-168.
[11] 屈玲, 李芳芹, 艾芳. 505株念珠菌感染特点及耐药性分析[J]. 国际检验医学杂志, 2011, 32(16):1830-1831.
[12] Farmakiotis D, Tarrand JJ, Kontoyiannis DP. Drug-resistant Candida glabrata infection in cancer patients[J]. Emerg Infect Dis, 2014, 20(11):1833-1840.
[13] Guinea J. Global trends in the distribution of Candida species causing candidemia[J]. Clin Microbiol Infect, 2014, 20(Suppl 6):5-10.
[14] Hirano R, Sakamoto Y, Kitazawa J, et al. Epidemiology, practice patterns, and prognostic factors for candidemia; and characteristics of fourteen patients with breakthrough Candida bloodstream infections:a single tertiary hospital experience in Japan[J]. Infect Drug Resist, 2018, 11:821-833.
[15] Barchiesi F, Orsetti E, Gesuita R, et al. Epidemiology, clinical characteristics, and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014[J]. Infection, 2016, 44(2):205-213.
[16] Luzzati R, Cavinato S, Deiana ML, et al. Epidemiology and outcome of nosocomial candidemia in elderly patients admitted prevalently in medical wards[J]. Aging Clin Exp Res, 2015, 27(2):131-137.
[17] Antinori S, Milazzo L, Sollima S, et al. Candidemia and invasive candidiasis in adults:A narrative review[J]. Eur J Intern Med, 2016, 34:21-28.
[18] Hadley S, Lee WW, Ruthazer R, et al. Candidemia as a cause of septic shock and multiple organ failure in nonimmunocompromised patients[J]. Crit Care Med, 2002, 30(8):1808-1814.
[19] Kullberg BJ, Arendrup MC. Invasive candidiasis[J]. N Engl J Med, 2015, 373(15):1445-1456.
[20] Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 62(4):e1-50.
[21] Guo LN, Xiao M, Cao B, et al. Epidemiology and antifungal susceptibilities of yeast isolates causing invasive infections across urban Beijing, China[J]. Future Microbiol, 2017, 12:1075-1086.
[22] Arendrup MC. Update on antifungal resistance in Aspergillus and Candida[J]. Clin Microbiol Infect, 2014, 20(Suppl 6):42-48.
[23] Morace G, Perdoni F, Borghi E. Antifungal drug resistance in Candida species[J]. J Glob Antimicrob Resist, 2014, 2(4):254-259.
[24] Cuenca-Estrella M. Antifungal drug resistance mechanisms in pathogenic fungi:from bench to bedside[J]. Clin Microbiol Infect, 2014, 20(Suppl 6):54-59.