西藏地区成人重症患者真菌检出情况及其影响因素分析  

Analysis of the Situation and Influencing Factors of Fungal Detection in Adult Patients with Severe Diseases in Tibet Region

作　　者：付建垒 苏龙翔 潘文君[1] 蔺国英[1] 柴文昭[3] 王小亭 FU Jianlei;SU Longxiang;PAN Wenjun;LIN Guoying;CHAI Wenzhao;WANG Xiaoting(Department of Critical Care Medicine,Tibet Autonomous Region People’s Hospital,Lhasa 850000,China;Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Infection Control,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]西藏自治区人民医院重症医学科,拉萨850000 [2]中国医学科学院,北京协和医学院,北京协和医院重症医学科,北京100730 [3]中国医学科学院,北京协和医学院,北京协和医院医院感染管理处,北京100730

出　　处：《协和医学杂志》2021年第5期791-797,共7页Medical Journal of Peking Union Medical College Hospital

摘　　要：目的探究西藏地区成人重症患者真菌检出现状,并进一步分析真菌检出的影响因素。方法回顾性纳入2018年1月1日至2019年12月31日西藏自治区人民医院重症医学科诊治的全部成人重症患者。根据其送检标本真菌检出结果,分为真菌检出阳性组、真菌检出阴性组。通过电子病历系统收集两组患者的临床资料及其检出真菌的菌株分布情况。采用多因素Logistic回归法分析真菌检出的影响因素。结果共755例符合纳入和排除标准的成人重症患者(送检标本4917份)纳入本研究,其中真菌检出阳性组142例、真菌检出阴性组613例。共检出真菌192株,其中念珠菌183株(95.3%)、曲霉7株(3.7%)、其他真菌2株(1.0%)。念珠菌中,白色念珠菌164株(89.6%)、光滑念珠菌9株(4.9%)、近平滑念珠菌7株(3.8%)、克柔念珠菌2株(1.1%)、热带念珠菌1株(0.6%)。曲霉中,烟曲霉3株(42.8%)、黑曲霉2株(28.6%)、黄曲霉2株(28.6%)。多因素Logistic回归分析结果显示,高序贯性器官衰竭评分(OR=1.402,95%CI:1.277~1.538,P<0.001)、消化系统重症(OR=2.671,95%CI:1.465~4.872,P=0.001)、气管插管时间≥48 h(OR=2.661,95%CI:1.611~4.397,P=0.000)、碳青霉烯类药物使用时间≥24 h(OR=2.825,95%CI:1.522~5.245,P=0.001)、头孢菌素类+β-内酰胺酶抑制剂类药物使用时间≥24 h(OR=2.678,95%CI:1.679~4.272,P=0.000)、长ICU住院时间(OR=1.043,95%CI:1.011~1.076,P=0.008)是成人重症患者真菌检出的独立危险因素,高居住地海拔(OR=0.999,95%CI:0.999~1.000,P=0.040)、高血红蛋白水平(OR=0.994,95%CI:0.988~0.999,P=0.020)是其保护因素。结论西藏地区成人重症患者真菌检出现象并非少见,白色念珠菌是检出的主要菌株。影响真菌检出的因素涉及多个方面,应基于西藏地区特征,针对危险因素采取相应的预防措施。Objective To explore the situation of fungal detection in adult patients with severe diseases in Tibet region,and further analyze the influencing factors of fungal detection.Methods All patients admitted to the Department of Critical Care Medicine Tibet Autonomous Region People’s Hospital from January 1,2018 to December 31,2019 were retrospectively analyzed.According to the results of fungal detection,the patients were then divided into the positive group and the negative group.The distribution of fungal strains detected and clinical data of the two groups were collected by the electronic medical record system.Multivariate Logistic regression was used to analyze the influencing factors of fungal detection.Results A total of 755 severe patients(4917 specimens were submitted)were enrolled,including 142 patients with positive fungal detection and 613 patients with negative fungal detection.Of which,192 fungal strains were detected,including 183(95.3%)Candida strains,7(3.7%)Aspergillus strains and 2(1.0%)other fungi strains.Among Candida genus,there were 164 strains(89.6%)of Candida albicans,9 strains(4.9%)of Candida glabrata,7 strains(3.8%)of Candida parapsilosis,2 strains(1.1%)of Candida krusei,and 1 strain(0.6%)of Candida tropicalis.Among Aspergillus,there were 3 strains(42.8%)of Aspergillus fumigatus,2 strains(28.6%)of Aspergillus niger,and 2 strains(28.6%)of Aspergillus flavus.Multivariate Logistic regression analysis showed that,high sequential organ failure assessment score(OR=1.402,95%CI:1.277-1.538,P<0.001),severe digestive diseases(OR=2.671,95%CI:1.465-4.872,P=0.001),the duration of tracheal intubation≥48 h(OR=2.661,95%CI:1.611-4.397,P=0.000),the use of carbapenemes≥24 h(OR=2.825,95%CI:1.522-5.245,P=0.001),the use of cephalosporins plus beta lactamase inhibitor≥24 h(OR=2.678,95%CI:1.679-4.272,P=0.000),and the long ICU stay(OR=1.043,95%CI:1.011-1.076,P=0.008)were independent risk factors for fungal detection in adult patients with severe diseases.High altitude of residence(OR=0.999,95%CI:0.999-1.000,

关 键 词：西藏地区 真菌 重症患者 影响因素 

分 类 号：R379[医药卫生—病原生物学]