酵母菌血症流行病学及影响近期病死率的危险因素分析  

Epidemiology and risk factors for short-term outcomes of yeast bloodstream infection——A five-year retrospective analysis

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

机构地区：[1]上海交通大学医学院附属瑞金医院急诊科&急诊重症监护室,上海200025 [2]上海交通大学医学院附属瑞金医院老年病科,上海200025 [3]上海交通大学医学院附属瑞金医院中法生命科学与基因组研究中心,上海200025 [4]上海交通大学医学院附属瑞金医院临床微生物科,上海200025

出　　处：《微生物与感染》2013年第4期234-243,共10页Journal of Microbes and Infections

摘　　要：酵母，尤其是假丝酵母（又称念珠菌）导致的血流感染逐年上升，且病死率高。本文回顾性研究上海交通大学附属瑞金医院2008年1月～2012年12月医院内获得性酵母菌血症患者的临床资料，分析其发生率、菌种分布、28d病死率及抗真菌治疗对预后的影响。结果显示，酵母菌血症发生率为0．34／1000人院患者。28d医院内病死率达27．1％。129例血流感染患者中，白念珠菌血症45例（34．9％），非白念珠菌血症84例（65．1％），其中近平滑念珠菌占18．6％、热带念珠菌占14．O％、光滑念珠菌占7．0％、季也蒙念珠菌占5．4％、清酒念珠菌占4．7％。101例患者（78．3％）行经验性抗真菌治疗，其中90例（69．8％）的经验性抗真菌治疗合适；28例（21．7％）未接受任何抗真菌治疗。发病5d内接受合适经验性抗真菌治疗患者的病死率（20．0％）显著低于未接受合适治疗患者（45．5％）。多因素Cox回归分析显示，年龄（HR=1．036，P=0．005）、中性粒细胞减少（HR=15．497，P〈0．001）及合适的抗真菌治疗与28d病死率有关（HR=0．325，P=0．002）。因此，早期诊断并进行及时适当的治疗是减少酵母菌血症病死率的有效方法。Yeasts, especially Candida, are important pathogens causing bloodstream infections （BSIs）, responsible for significant mortality and morbidity among hospitalized patients. The present paper aims to report the current epidemiology of yeast BSI in Ruijin Hospital from January 2008 to December 2012, and to estimate the impact of appropriate antifungal therapy on the outcomes. The incidence of nosocomial yeast BSI was 0.34 episodes/1 000 hospitalized patients, and the overall 28-day mortality rate was 27.1%. The proportion of yeast BSI caused by non-Candida albicans （65.1%） including C. parapsilosis （18.6%）, C.tropicalis （14.0%）, C. glabrata （7.0%）, C. guilliermondii （5.4%） and C. sake （4.7%） was higher than that of C. albicans （34.9%）. Among the 129 cases of yeast BSI, 21.7% （28 cases） did not receive any antifungal agent, and 78.3% （101 cases） received empiric antifungal therapy of which only 69.8% （90 cases） were considered appropriate. The mortality rate was significantly lower in those who received appro- priate empiric antifungal therapy compared with those who received inappropriate empiric antifungal therapy （20.0% vs. 45.5%, P=0.006） within 5 d of the onset. The age （HR = 1.036, P = 0.005） and neutropenia 〈500/mm3 （HR = 15. 497, P%0. 001） were independent risk factors for the 28-day mortality rate, while appropriate empiric antifungal therapy （HR = 0. 325, P = 0. 002） was a positive protective factor for short-term survival rate.

关 键 词：酵母 血流感染 病死率 合适的经验性抗真菌治疗 

分 类 号：R519[医药卫生—内科学]