念珠菌菌血症患者血标本分离菌特点和预后不良的危险因素分析  

Analysis of isolation characteristics and risk factors for clinical outcome of Candidiasis

作　　者：彭善鑫 孙淑红[1,3] 朱晓松 卓凤娟 左志文[1,2] 李洪艳 孙志清[1,2] PENG Shanxin;SUN Shuhong;ZHU Xiaosong;ZHUO Fengjuan;ZUO Zhiwen;Li Hongyan;SUN Zhiqing(Institute of Multi-resistant Bacterial and Fungal Infection Control,Linyi People's Hospital,Linyi,Shandong 276000,China;Department of Hospital Infection Management,Linyi People's Hospital,Linyi,Shandong 276000,China;Microbiology Laboratory,Linyi People's Hospital,Linyi,Shandong 276000,China)

机构地区：[1]临沂市人民医院多重耐药菌与真菌感染控制研究所 [2]临沂市人民医院医院感染管理部 [3]临沂市人民医院微生物检验科,山东临沂276000

出　　处：《国际检验医学杂志》2023年第3期297-300,共4页International Journal of Laboratory Medicine

基　　金：山东省自然科学基金青年项目(ZR2020QH114);临沂市人民医院博士创新基金(2019LYBS09)。

摘　　要：目的分析念珠菌菌血症的分离菌分布特点、药敏特性及其临床结局危险因素。方法选取2019年4月至2022年3月念珠菌菌血症患者临床标本中分离的73株菌,经质谱仪鉴定、微量肉汤稀释法药敏试验测定,收集并分析相关临床资料。结果本研究中白念珠菌和热带念珠菌的总体分离率分别为35.61%和23.29%,分别是重症监护室(ICU)和血液内科最主要的检出菌。本次研究未发现对5-氟胞嘧啶和两性霉素B耐药的分离株;而热带念珠菌对三唑类抗真菌药物的敏感率均不足60.00%。氟康唑在念珠菌菌血症抗感染治疗中的使用率最高,为46.88%。经单因素、多因素Logistic回归分析发现,感染性休克是影响患者临床结局的危险因素(P<0.05)。结论本次研究中,白念珠菌是ICU的主要检出菌;合并感染性休克与患者死亡密切相关;热带念珠菌是血液内科的主要检出菌,其对三唑类抗真菌药物敏感性不高,临床经验性用药应结合区域流行病学特征。Objective To investigate the distribution characteristics and drug sensitivity of Candidiasis isolates,and the risk factors for clinical outcomes of Candidiasis.Methods A total of 73 strains of Candida from candidemia were collected from April 2019 to March 2022.The Candida species were identified by MALDI-TOF,and their drug sensitivity tests were performed by broth dilution method.The relevant clinical data were collected and analyzed.Results During the study period,Candida albicans and Candida tropicalis,whose overall isolation rates of were 35.61%and 23.29%,were the most pathogenic fungi detected in intensive care unit(ICU)and hematology department.The isolates resistant to 5-flucytosine and amphotericin B were not found in this study.The sensitivity rate of triazole antifungal agents in candida tropicalis was less than 60.00%.The utilization rate of fluconazole in anti-infection treatment of candidiasis was 46.88%.Univariate and multivariate Logistic regression analysis showed that septic shock was a risk factor affecting clinical outcome(P<0.05).Conclusion In the study,Candida albicans was the main isolated strains in ICU.The septic shock is closely associated with the death of the patients.Candida tropicalis is the main isolated strains in the department of hematology,which is not highly sensitive to triazole antifungal drugs.And clinical empirical drug use of candidiasis should be combined with regional epidemiological characteristics.

关 键 词：念珠菌菌血症 血流感染 临床结局 危险因素 抗真菌药物 

分 类 号：R446.5[医药卫生—诊断学]