250例真菌性血流感染的临床特点分析  

Clinical characteristics of 250 patients with fungal bloodstream infections

作　　者：凌勇[1] 侯铁英[1] 陈柳勤[1] 张玉[1] 陈晓丽[1] 

机构地区：[1]广东省人民医院,广东省医学科学院检验科,广东广州510080

出　　处：《中华医院感染学杂志》2016年第21期4876-4878,4881,共4页Chinese Journal of Nosocomiology

基　　金：广东省科技计划项目(2015A050502033)

摘　　要：目的研究广东省人民医院真菌性血流感染患者的病原学及临床特点,进一步探讨真菌性血流感染的防治措施。方法回顾性分析医院250例真菌性血流感染患者的临床资料,描述其基础疾病、危险因素、转归等,并采用χ2检验,进行预后单因素分析,采用logistic回归进行预后多因素分析。结果 250例患者血培养共分离出真菌261株,真菌中最常见的是念珠菌属234株占89.7%;住院期间因各种原因死亡87例,粗病死率为34.8%;其中因真菌性血流感染死亡50例,归因病死率为20.0%;单因素分析显示中心静脉置管、机械通气、留置尿管、留置引流管、ICU治疗、使用糖皮质激素、年龄≥60与住院期间死亡相关;多因素分析中,气管插管、年龄≥60、使用糖皮质激素增加真菌性血流感染患者住院期间死亡风险。结论真菌性血流感染病原菌以念珠菌属为主,尤其是白色念珠菌,出现真菌性血流感染的患者预后差,气管插管、年龄≥60、使用糖皮质激素等增加真菌性血流感染患者住院期间死亡风险。OBJECTIVE To investigate the etiological and clinical characteristics of patients with fungal bloodstream infections in Guangdong People＇s Hospital Guangdong Academy of Medical Science and further explore the preven- tion measures for the fungal bloodstream infections. METHODS The clinical data of 250 patients with fungal blood- stream infections were retrospectively analyzed, then the underlying diseases, risk factors, and outcomes were de- scribed, the univariate analysis of the prognosis was carried out by means of chi-square test, and the multivariate logistic regression analysis of the prognosis was performed. RESULTS A total of 261 strains of fungi were isolated from the blood culture that was conducted for the 250 patients. The Candida spp was,dominant among the isola- ted fungi, accounting for 89.7% （234 strains ）. Totally 87 patients died due to a variety of causes during the hos- pital stay, with the crude mortality rate 34.8%; 50 patients died of the fungal bloodstream infections, with the at- tributable mortality rate 20.0%. The univariate analysis indicated that the mortality during the hospital stay was associated with the central venous catheter indwelling, mechanical ventilation, urinary catheter indwelling, drain- age tube indwelling, treatment in ICU, use of glucocorticoids, and no less than 60 years of age. The multivariate analysis showed that the endotracheal intubation, no less than 60 years of age, and use of glucocorticoids may increase the risk of mortality of the patients with fungal bloodstream infections during the hospital stay. CONCLUSION The Candida spp is dominant among the pathogens causing the fungal bloodstream infections, es- pecially the Candida albicans. The prognosis of the patients with fungal bloodstream infections is poor. The endotracheal intubation, no less than 60 years of age, and use of glucocorticoids may increase the risk of mortality of the patients with fungal bloodstream infections during the hospital stay.

关 键 词：真菌性血流感染 临床特点 预后 危险因素 

分 类 号：R379[医药卫生—病原生物学]