心脏手术后真菌感染病原学特征与危险因素分析  

Etiology and Risk Factors of Fungal Infection in Patients After cardiac surgery

作　　者：王蔚莎 侯铁英[1] 刘素玲[1] 李正康[1] 

机构地区：[1]广东省人民医院检验科广东省医学科学院,广东广州510080

出　　处：《中国实验诊断学》2017年第7期1137-1140,共4页Chinese Journal of Laboratory Diagnosis

基　　金：广东省协同创新与平台环境建设专项基金(项目编号:2015A050502033)

摘　　要：目的分析心脏外科术后真菌感染的发生情况及其危险因素,为预防术后真菌感染提供科学依据。方法收集某三甲医院心脏外科手术病区2011年1月至2015年12月心脏手术后真菌感染患者32例的临床资料,随机抽取同期心脏术后无真菌感染患者188例作为对照组,运用卡方检验及二分类Logistic回归分析方法,探索心脏手术后真菌感染发生的危险因素。结果对32例真菌感染患者的病原菌特点分析发现,主要感染的真菌为念珠菌(90.6%,29/32),其中白假丝酵母菌占56.3%(18/32),近平滑念珠菌占18.8%(6/32));感染来源以血液感染为主,占87.5%(28/32);9例发生真菌合并细菌感染;死亡7例,病死率21.9%。对真菌感染的危险因素进行单因素和多因素分析发现,住院时间≥30天、使用碳青霉烯类药物、使用万古霉素、使用抗菌药物≥7天与术后真菌感染相关(P值均小于0.05),经多因素logistic回归调整后,仅发现住院时间≥30天和使用抗菌药物≥7天是术后真菌感染的危险因素,其风险比分别为4.98(P=0.001)和6.68(P<0.001)。结论住院时间和抗菌药物使用时间延长是心脏术后真菌感染的独立危险因素;念珠菌在术后真菌血流感染病原菌中占主导地位;术后真菌感染病死率高,应引起临床重视。Objective To explore the risk factors of fungal infection in patients under going cardiac surgery.Methods 32 patients who had fungal infection after cardiac surgery were chosen as fungal infection group and 188 patients after cardiac surgery with no fungal infection were simultaneously selected as the control group at random from January 2011 to December 2015 in a Certain Grade-three General Hospital.The SPSS 17.0 statistical software was used for the chi-square and the Multivariate Logistic regression analysis of risk factors after cardiac surgery.Results The pathogen was main candida（90.6%,29/32）,Among them,Candida albicans,accounting for 56.3%（18/32）,followed by Candida parapsilosi,accounting for 18.8%（6/32）;The main Infection Sources were blood,accounting for 87.5%（28/32）;Co-infections occurred in 9 fungous infection;and 7 cases died,with the mortality rate of 21.9%.One way analysis of variance showed that hospital stay time≥ 30 days,specific antibiotics use,broad-spectrum antibiotics use time ≥7 days is associated with postoperative fungal infection（P〈0.05）.Logistic regression revealed that the high risk factors of fungal infection mainly included：hospital stay time ≥30 days,broad-spectrum antibiotics use time ≥7 days.The hazard ratio were 4.98（P=0.001）and 6.68（P〈0.001）,respectively.Conclusion Long-term hospitalization and long-term use antibacterial drugs were independent risk factors for postoperative fungal infection;candida plays a vital role in fungal bloodstream infection;It is always an important thing with high fatality that doctors concerned.

关 键 词：心脏手术 真菌感染 危险因素 

分 类 号：R446.5[医药卫生—诊断学]