肿瘤患者念珠菌血流感染的流行病学研究  

Epidemiology of candidemia among patients with tumor

作　　者：李丁[1] 夏睿[1] 陈颖[1] 张文芳[1] 郑珊[1] 张青[1] 白长森 张鹏[1] 

机构地区：[1]天津医科大学肿瘤医院检验科国家肿瘤临床医学研究中心天津市“肿瘤防治”重点实验室,300060

出　　处：《中华传染病杂志》2015年第1期34-37,共4页Chinese Journal of Infectious Diseases

基　　金：“863”课题（子）资助项目（2011AA02A111）;国家自然科学基金资助项目（81302250,81372307,81101745）;天津市卫生局科技基金资助项目（2012KZ073）;天津市应用基础与前沿技术研究计划青年基金项目（13JCQNJC10300）

摘　　要：目的 分析并探讨肿瘤患者念珠菌血流感染的流行病学特征,为临床对该类疾病的诊治提供理论依据.方法 回顾性分析2006年1月至2013年12月天津医科大学肿瘤医院发生院内念珠菌血流感染的肿瘤患者的临床资料,对患者的临床特点、感染的病原菌分布特征和药物敏感情况进行研究.采用Fisher确切概率法对分类变量进行分析.结果 共80例成人肿瘤患者发生念珠菌血流感染,30 d粗病死率为30.0％.其中中心静脉导管留置7d以上及接受过化学治疗的患者比例均超过半数（分别为55.0％和57.5％）,胃肠道手术患者约为非胃肠道手术患者的2倍（46.2％比25.0％）.主要病原菌仍为白念珠菌（55.0％）,其次为近平滑念珠菌（21.2％）、热带念珠菌（8.8％）及光滑念珠菌（7.5％）,未见氟康唑及伏立康唑耐药菌株.结论 念珠菌血流感染病死率高.长期中心静脉导管留置、接受化学治疗及胃肠道手术的患者感染率较高.主要病原菌仍为白念珠菌,未见唑类药物耐药菌株.Objective To evaluate the epidemiology of candidemia in patients with tumor and provide scientific basis for candidemia diagnosis and treatment.Methods All cases of nosocomial candidemia in patients with tumor at Tianjin Medical University Cancer Institute and Hospital from January 2006 to December 2013 were retrospectively collected.Clinical characteristics,distributions and drug susceptibility profiles of causative microorganisms were analyzed.Categorical data were compared using Fisher exact test.Results A total of 80 episodes of candidemia were included in the study.Among these patients,30-day crude mortality was 30.0％.More than half of the patients had detained central venous catheter for more than 7 days （55.0％） and chemotherapy （57.5％）,and patients who received gastrointestinal surgery were almost two times more than those who received non-gastrointestinal surgery （46.2％ vs 25.0％）.Candida albicans was still predominated （55.0％）,and followed by Candida parapsilosis （21.2％）,Candida tropicalis （8.8％）,Candida glabrate （7.5％）.None isolates were resistant to fluconazole and voriconazole.Conclusions Candidemia exhibits high mortality,and often occurrs in patients with long time of central venous catheterization,previous chemotherapy and gastrointestinal surgery.Candida albicans is the most common causative pathogen,and none of the 80 Candida species exhibited resistance to azoles.

关 键 词：念珠菌属 血流感染 肿瘤 流行病学 

分 类 号：R730.43[医药卫生—肿瘤]