院内获得性真菌血症的临床特点及预后危险因素分析  

Clinical characteristic and prognostic risk of nosocomial yeast septicemia

作　　者：吴霖[1] 刘晓颖[2] 周敏[3] 杨之涛[2] 熊丽萍[4] 吴佳胤[4] 李洁[3] 陈影[2] 毛恩强[2] 陈尔真[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院老年病科,上海200025 [2]上海交通大学医学院附属瑞金医院急诊科,上海200025 [3]上海交通大学医学院附属瑞金医院临床微生物科,上海200025 [4]上海交通大学医学院附属瑞金医院信息统计科,上海200025

出　　处：《内科理论与实践》2013年第1期39-44,共6页Journal of Internal Medicine Concepts & Practice

摘　　要：目的：探讨院内获得性真菌血症的临床特点及预后危险因素。方法：回顾我院2008年1月1日至2012年9月30日连续的院内获得性真菌血症患者的临床资料,分析其发生率、真菌种类分布、药敏以及发生真菌血症后第28天和第12周病死率及影响因素。结果：在观察期内共入院患者353 907例,其中共117例次发生院内获得性真菌血症,发生率为3.31/万。其中,白念珠菌占36.8%,其次为近平滑念珠菌（18.8%）、热带念珠菌（13.7%）、光滑念珠菌（6.0%）、季也蒙念珠菌（6.0%）、克柔念珠菌（4.3%）、清酒念珠菌（4.3%）,其他酵母样菌占5.1%。热带念珠菌血症与血液系统恶性肿瘤有关;克柔念珠菌、光滑念珠菌血症与机械通气及3个月内的抗真菌药物暴露史有关。白念珠菌和近平滑念珠菌对氟康唑的敏感率最高,分别为92.7%和95.5%。真菌血症发病后第28天及第12周的总病死率为27.4%及38.5%,不同菌种间病死率差异无统计学意义。第12周病死率年龄〉65岁患者高于20~65岁及〈20岁患者（P=0.032）,内科、重症监护病房（ICU）患者高于外科患者（分别为40.0%、57.1%和20.0%,P=0.002）。结论：白念珠菌仍是院内获得性真菌血症的主要致病菌,但非白念珠菌血症已呈上升趋势;其发病因素呈多样性分布。内科和ICU来源的念珠菌血症患者的病死率仍然很高,经验性抗真菌药物使用仍需加强。Objective To analyze the clinical characteristic and prognostic risk of nosocomial yeast septicemia. Methods All the patients who developed nosocomial yeast septicemia from January 2008 to September 2012 at Ruijin Hospital were enrolled in the study. Data concerning the nosocomial yeast septicemia including clinical features, fungus species, drug sensitivity, and survival at 28 days and 12 weeks after diagnosis were analyzed. Results A total of 117 cases/times of nosocomial yeast septicemia were identified, with an incidence of 3.31 /10 000 admissions. The causative organisms were： C. albicans （36.8%）, C. parapsilosis （18.8%）, C. tropicalis （13.7%）, C. guilliermondii （6.0%）, C. glabrata （6.0%）, C. sake （4.3%） and other yeast species （5.1%）. C. tropicalis septicemia had an association with hematologic malignancy, and C. glabratal C. krusei septicemia had an association with prior use of antifungal agents and mechanical ventilation. The overall mortality rates at 28 days and 12 weeks were 27.4% and 38.5%, respectively. The mortality rates were not significantly different among different fungus species. The mortality rate at 12 weeks in patients aged 〉65 years old was higher than patients aged 20-65 and 〈20 years old（P=0.032）, and patients in the medical ward and intensive care unit （ICU） was higher than patients in the surgical ward （40.0%, 57.1% and 20.0% respectively, P=0.002）. Conclusions C.albicans is still the major causative organism of nosocomial yeast septicemia, but the non-C.albicans has a trend to increase. The mortality rate of nosocomial yeast septicemia in ICU and medical ward is still high, and the rational use of anti-fungal drugs should be emphasized.

关 键 词：院内感染 白念珠菌 念珠菌血症 

分 类 号：R519.3[医药卫生—内科学]