医院获得性念珠菌血症109例临床特点及预后因素分析  

Clinical epidemiology and prognostic analysis of 109 cases of nosocomial candidemia

作　　者：吴吉芹[1] 朱利平[1] 区雪婷[1] 徐斌[1] 胡秀平[1] 王璇[1] 翁心华[1] 

机构地区：[1]复旦大学附属华山医院感染科,上海200040

出　　处：《中华传染病杂志》2011年第4期206-210,共5页Chinese Journal of Infectious Diseases

摘　　要：目的了解医院获得性念珠菌血症的临床特征。方法回顾性分析复旦大学附属华山医院10年（1998—2007年）间医院获得性念珠菌血症109例，描述其基础特征、相关危险因素、临床表现、治疗和转归等，并采用x^2。检验或Fisher精确概率法进行预后单因素分析，采用多元Logistic回归进行预后多因素分析。结果念珠菌血症平均发病率为每天0．28／10000例患者。血流感染致病菌株中白念珠菌59例，占54．1％；其次为热带念珠菌20例，占18．3％；光滑念珠菌11例，占10．1％；近平滑念珠菌11例，占10．1％；其他念珠菌8例，占7．3％。常见基础疾病包括糖尿病50例，占45．9％；实体恶性肿瘤32例，占29．4％；脑部外伤13例，占11．9%；脑卒中12例，占11．0％。出院时死亡或病情恶化37例，总病死率为34．0％，其中归因病死率22．0％（24／109）。预后多元回归分析显示，与患者出院病死率增高独立相关的因素包括未置换深静脉导管（OR：5．42，95％CI：1．68～17．41，P=0．005）、使用糖皮质激素（OR：3．69，95％CI：1．10～12．34，P=0．034）以及血培养阳性当天重型脓毒症（OR：2．94，95％CI：1．72～15．21，P=0．003），而接受合理抗真菌治疗者出院病死率较低（0R：0．27，95％CI：0．09～O．78，P=0．015）。结论医院获得性念珠菌血症发病率近10年呈上升趋势，而早期诊断和及时治疗是降低其病死率的关键。Objective To understand the clinical epidemiology of nosocomial candidemia in Huashan Hospital during a lO-year period. Methods One hundred and nine cases of nosocomial candidemia in Huashan Hospital affiliated Fudan University during the period of 1998--2007 were retrospectively reviewed. The underlying conditions, risk factors, clinical manifestations, treatment and outcome were described. The prognostic factors were analyzed by chi square test or Fisher exact probability test. Multivariate analysis was done by multiple Logistic regression. Results The average annual incidence of nosocomial candidemia during the study period was 0.28/10 000 patients per day. The most common pathogen was C, albicans （59/109,54. 1%）, followed by C. tropicalis （20/109, 18.3%）, then C. parapsilosis （11/109, 10. 1%）, C. glabrata （11/109, 10.1%）, and other Candida spp. （8/109, 7.3% ）. Underlying diseases frequently identified included diabetes （50, 45.9%）, solid malignancy （32, 29.4%）, head trauma （13, 11. 9%） and stroke （12, 11. 0%）. There were 37 cases who died or deteriorated. The overall mortality was 34.0% and the attributable mortality was 22. 0% （24/109）. In multivariate prognostic analysis, retention of central venous catheters （OR： 5.42, 95%CI： 1. 68--17.41, P=0.005）, corticosteroid medication （OR： 3. 69,95% CI： 1.10--12.34, P=0. 034）, and severe sepsis on the day of candidemia （OR： 2.94, 95% CI： 1.72-15. 21, P= 0. 003） were factors independently correlated to increased mortality. Furthermore, adequate antifungal therapy was the only independent predictor of decreased overall mortality （OR： O. 27, 95% CI： O. 09--0.78,P=0. 015）. Conclusions The incidence of nosocomial candidemia in our hospital has been increasing during the past decade. Timely diagnosis and treatment plays a key role in the management of nosocomial eandidemia.

关 键 词：念珠菌病 菌血症 交叉感染 预后 早期诊断 糖皮质激素 

分 类 号：R519.3[医药卫生—内科学]