老年与中青年念珠菌血流感染患者抗真菌药物应用及预后比较  

Comparisons of clinical characteristics, antifungal exposure and outcome between elderly patients and young and middle-aged patients with Candida bloodstream infection

作　　者：王昊[1] 吴大玮[1] 刘乃政[2] 韩辉[1] 岳金凤[1] 张帆[1] 单梯超 郭海鹏[1] 尹梅[3] 

机构地区：[1]山东大学齐鲁医院重症医学科,济南250012 [2]聊城市人民医院急诊科 [3]山东大学齐鲁医院老年病科,济南250012

出　　处：《中华老年医学杂志》2014年第8期866-870,共5页Chinese Journal of Geriatrics

基　　金：山东省自然科学基金（ZR2012HM005）;教育部博士点基金（20120131120066）

摘　　要：目的 探讨老年与中青年念珠菌血流感染（CBSI）患者的临床特征、抗真菌药物应用及预后的差异. 方法 回顾性分析比较2009年1月至2010年6月入住山东省4所三甲医院老年CBSI患者43例和中青年CBSI患者60例的临床资料. 结果 与中青年组比较,老年组合并实体肿瘤、2型糖尿病、慢性肾功能不全及入住重症监护病房、接受机械通气和中心静脉置管的比例明显增加（均P＜0.05）.老年组中,非白色念珠菌分离率比中青年组升高约10.0％（65.0％比55.8％）,对氟康唑耐药率约为中青年组的2倍（29.2％比15.4％）.老年组接受三唑类抗真菌治疗者较少（58.1％比80.0％,P＜0.05）,未接受抗真菌治疗者较多（23.3％比8.3％,P＜0.05）;老年组急性生理与慢性健康Ⅱ评分[（20.1±8.2）分比（14.9±7.4）分]、序贯器官衰竭估计评分[（7.5±4.3）分比（4.6±3.8）分]和住院病死率（37.2％比18.3％）均明显高于中青年组（均P＜0.05或0.01）.生存分析显示,老年患者90 d生存率显著降低（P＜0.001）. 结论 与中青年患者比较,老年CBSI患者有其特殊的病原学特征、危险因素和抗真菌药物应用特点,预后较差.Objective To investigate the differences of clinical characteristics,antifungal exposure and outcome between elderly patients and young and middle-aged patients with Candida bloodstream infection（CBSI）.Methods During the study period from January 2009 to June 2010,clinical data of forty three elderly patients and sixty young and middle-aged patients with CBSI in four tertiary hospitals of Shandong province were retrospectively reviewed.Results Compared with young and middle-aged patients,the percentages of patients with solid tumor,type 2 diabetes mellitus,chronic renal dysfunction,and undergoing intensive care unit admission,mechanical ventilation and central venous catheterization were higher in the elderly patients（all P〈0.05）.Isolation rate of non-Candida albicans species was increased by 10.% in elderly patients as compared with young and middle-aged patients,although it had no significant difference （65.0% vs.55.8%,P〉 0.05）.The resistance rate to fluconazole of non-Candida albicans species in elderly patients was nearly twice that in young and middle aged patients （29.2% vs.15.4%）.Compared with young and middle-aged patients,elderly patients receiving triazoles treatment were less（58.1% vs.80.0%,P〈0.05） and patients without antifungal therapy were more（23.3% vs.8.3%,P〈0.05）.Elderly patients had significantly higher Acute Physiology and Chronic Health Evaluation Ⅱ score [（20.1± 8.2） vs.（14.9 ±7.4）],higher Sequential Organ Failure Assessment score [（7.5±4.3） vs.（4.6±3.8）] and longer hospital mortality （37.2% vs.18.3%） than young and middle-aged patients（P〈0.05 or 0.01）.When followed up until 90 days,significant lower survival rate was observed in elderly patients （log-rank test：P〈0.001）.Conclusions Compared with young and middle-aged CBSI patients,elderly CBSI patients have special pathogen features,risk factors,antifungal exposure,and poor prognosis.

关 键 词：念珠菌病 抗真菌药 

分 类 号：R519.3[医药卫生—内科学]