55例念珠菌血症的临床与实验室特点分析  

Analysis of clinical and laboratory characteristics of 55 cases of candidemia

作　　者：田鹏鹏[1] 王娴默[1] 易华伟 TIAN Pengpeng;WANG Xianmo;YI Huawei(Clinical Laboratory of the First Affiliated Hospital of Yangtze University,Jingzhou 434000,China)

机构地区：[1]长江大学附属第一医院检验科,荆州434000

出　　处：《中国真菌学杂志》2024年第4期337-341,共5页Chinese Journal of Mycology

基　　金：湖北省自然科学基金青年项目(2021CFB216)。

摘　　要：目的探讨念珠菌血症的流行病学、临床特点、病原体分布、药敏试验结果以及预后情况,为临床念珠菌血症病原学诊断和合理使用抗真菌药物提供依据。方法回顾性分析长江大学附属第一医院2019年1月—2022年12月念珠菌菌血症的临床资料,对真菌种类、阳性报警时间、标本送检科室、抗真菌药物敏感性试验结果进行分析。结果共收集念珠菌血症患者55例,排名前3位念珠菌分别为近平滑念珠菌16株(29.1%)、白念珠菌16株(29.1%)、热带念珠菌14株(25.5%),其中热带念珠菌阳性报警时间最短(21.1±7.8)h。念珠菌血症分布排名前3的科室是重症监护病房(ICU)18例(32.7%)、血液肿瘤科11例(20.0%)和肝胆外科10例(18.2%)。腹腔感染是最常见的感染源。所有念珠菌对5-氟胞嘧啶敏感,但对其他抗真菌药物出现不同程度的耐药,热带念珠菌对唑类耐药率最高。念珠菌血症患者30 d病死率为32.7%,年龄、恶性肿瘤、入住ICU、感染性休克、外科手术、高水平降钙素原及合并细菌血流感染是30 d死亡的危险因素。结论念珠菌血症以非白念珠菌为主,大多数临床菌株对抗真菌药物敏感,患者常合并基础疾病且有多种危险因素,其预后较差,应引起临床医生的足够重视。Objective To investigate the epidemiology,clinical characteristics,pathogen distribution,antifungal susceptibility and outcome of candidemia,so as to provide basis for clinical pathogenic diagnosis of candidaemia and rational use of antifungal drugs.Methods Clinical and laboratory data of patients with candidemia in the first affiliated hospital of Yangtze university from January 2019 to December 2022 were retrospectively analyzed.The fungal species,time to positive,specimen delivery department and antifungal susceptibility test were analyzed.Results A total of 55 patients with candidaemia were collected.The first three Candida isolates were Candida parapsilosis(16 strains,29.1%),Candida albicans(16 strains,29.1%),Candida tropicalis(14 strains,25.5%)respectively.The time to positive of Candida tropicalis was the shortest(21.1±7.8)h.The top three departments of candidemia was the intensive care unit(ICU)with 18 cases(32.7%),hematology with 11 cases(20.0%)and hepatobiliary surgery with 10 cases(18.2%).Abdominal infection was the most common source of infection.All Candida were sensitive to 5-fluorocytosine and showed varying degrees of resistance to other antifungal drugs,especially Candida tropicalis had the highest resistant rate to azoles.The 30-day mortality rate of patients with candidaemia was 32.7%.Ages,malignancy,ICU admission,septic shock,surgical operation,high level of procalcitonin and combined bacterial bloodstream infection were risk factors for 30-day mortality.Conclusion Candidemia was predominantly caused by non-Candida albicans,and most strains were sensitive to some antifungal drugs,patients accompanied by a variety of risk factors and severe underlying diseases had poor prognosis,which should attract sufficient attention of clinicians.

关 键 词：念珠菌血症 阳性报警时间 危险因素 敏感性 

分 类 号：R519.3[医药卫生—内科学]