念珠菌血流感染病原学及影响预后的危险因素分析  

The pathogenies and risk factors of candidemia

作　　者：刘蓉[1] 乔莉[1] 张劲松[1] 

机构地区：[1]南京医科大学第一附属医院急诊科,南京210029

出　　处：《临床急诊杂志》2015年第1期5-8,共4页Journal of Clinical Emergency

摘　　要：目的：研究影响念珠菌血流感染的病原学分布及影响预后的危险因素。方法：回顾性分析2009-12-2013-01南京医科大学第一附属医院48例住院患者的念珠菌血流感染的病历资料。根据出院时的预后分为死亡组（16例）和存活组（32例）,收集人口学资料、入住单元、基础疾病、有创操作、血培养菌株及耐药性、入院时急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和序贯器官衰竭估计（SOFA）评分;通过多因素logistic回归分析确定影响念珠菌血流感染预后的危险因素。同时通过比较白色念珠菌与非白色念珠菌血流感染的差别,分析念珠菌血流感染病原学及耐药性特点与变化。结果：48例念珠菌血流感染患者中白色念珠菌14例（29.2%）,非白色念珠菌34例（70.8%）。APACHEⅡ评分（OR 1.140,95%CI 1.016~1.279,P〈0.05）与血清白蛋白低于25g/L（OR 25.565,95%CI 2.388~273.695,P〈0.01）是念珠菌血流感染预后不佳的危险因素。结论：念珠菌血流感染的病原菌以非白色念珠菌为主,尤其是光滑念珠菌,念珠菌对氟康唑的耐药性较高。入院时APACHEⅡ评分、血清白蛋白（ALB）低于25g/L是念珠菌血流感染死亡的危险因素。Objective： To assess the distribution of candida species and the risk factors of fatal candidemia. Method：This retrospective study examined all 48 patients whose candidemia were diagnosed during the period of December 2009 to January 2013 in First Affiliated Hospital of Nanjing Medical University. Patients were divided into the death group（16 cases） and the survivor group（32 cases） based on the outcome when discharged from hos- pital. Demographic data, admission unit,comorbidities, invasive factors, candida species and antifungal susceptibili- ty,APACHE Ⅱ and SOFA score were collected. Multivariable logistic regression analysis was used to identify in- dependent risk factors of fatal candidemia. The distribution of candida species and antifungal susceptibility were al- so tanken into consideration. Result：Candida albicans and non-albicans spp. were responsible for 29.2%（14 of 48） and 70. 8% （34 of 48） of candidemia. Multivariate analysis revealed that APACHE Ⅱ （odds ratio, 1. 140,95% confidence interval, 1.016 -1.279, P〈 0.05） and serum albumin 〈25 g/L （ odds ratio, 25.565,95 % confidence interval,2. 388-273. 695 ,P〈0.01） were independent risk factors for fatal candidemia. Conclusion： Our findings sug- gest that non-albicans spp. takes up the majority of candidemia,especially Candida glabrata. Candidemia has a high drug resistance rate to fluconazole. APACHE Ⅱand serum albumin 〈25 g/L are independent risk factors for fatal candidemia.

关 键 词：念珠菌 血流感染 危险因素 APACHEⅡ评分 血清白蛋白 

分 类 号：R631[医药卫生—外科学]