ICU假丝酵母血流感染患者临床特征及预后危险因素  

Clinical characteristics of ICU patients with Candida bloodstream infection and risk factors for prognosis

作　　者：郭婧 黄雅轩 张莉滟 赵越 GUO Jing;HUANG Ya-xuan;ZHANG Li-yan;ZHAO Yue(Maternity and Child Health Care of Guangri Zhuang Autonomous Region,Nanning,Guangri 530003,China;不详)

机构地区：[1]广西壮族自治区妇幼保健院检验科,广西南宁530003 [2]南加州大学Alfred E.Mann药学与制药科学学院,洛杉矶90089 [3]南方医科大学附属广东省人民医院/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》2024年第17期2589-2593,共5页Chinese Journal of Nosocomiology

基　　金：广东省基础与应用基础研究基金项目(2021A1515220022)。

摘　　要：目的探讨医院重症监护室(ICU)假丝酵母血流感染患者的临床特征及预后危险因素,为其诊治及预后改善提供理论依据。方法回顾性分析2018年1月-2023年3月广东省人民医院ICU假丝酵母血流感染患者的临床资料及预后情况,并对生存和死亡患者间的相关危险因素进行比较分析。结果134例ICU假丝酵母血流感染患者中,白假丝酵母分离率最高(49株,36.57%),其次为近平滑假丝酵母(28株,20.89%)、光滑假丝酵母(23株,17.16%)和热带假丝酵母(20株,14.93%)等,药敏结果显示光滑假丝酵母和热带假丝酵母对唑类抗真菌药物的耐药率较高;134例患者中死亡42例,病死率为31.34%,死亡组患者平均年龄高于生存组(t=2.255,P=0.026);单因素分析显示:患者伴有恶性肿瘤、使用糖皮质激素、碳青霉烯类药物以及>3种抗菌药物联用与预后相关,多因素Logistic回归分析显示:患者伴有恶性肿瘤和使用糖皮质激素是影响其预后的危险因素。结论ICU假丝酵母血流感染患者病死率高,同时临床需尽早完善患者血培养送检,并加强药物管理及临床护理工作,以降低假丝酵母血流感染风险,改善患者预后。OBJECTIVE To explore the clinical characteristics of intensive care unit(ICU)patients with Candida bloodstream infection and analyze the risk factors for prognosis so as to provide theoretical bases for diagnosis,treatment and improvement of prognosis.METHODS The patients with Candida bloodstream infection who were treated in ICU of Guangdong Provincial People′s Hospital from Jan 2018 to Mar 2023 were enrolled in the study,the clinical data and treatment outcomes of the enrolled patients were retrospectively analyzed,and the related risk factors were observed and compared between the survived patients and the dead patients.RESULTS Among the 134 strains of Candida that were isolated from the ICU patients with bloodstream infection,there were 49(36.57%)strains of Candida albicans,28(20.89%)strains of Candida parapsilosis,23(17.16%)strains of Candida glabrata and 20(14.93%)strains of Candida tropicalis.The result of drug susceptibility testing showed that the drug resistance rates of the C.glabrata and C.tropicalis to azole antifungal agents were relatively high.Totally 42 patients died among the 134 patients,with the mortality rate 31.34%.The average age of the death group was higher than that of the survival group(t=2.255,P=0.026).The result of univariate analysis showed that malignant tumor,use of glucocorticoids,carbapenems and combined use of more than 3 types of antibiotics were associated with the prognosis.The result of multivariate logistic regression analysis indicated that malignant tumor and use of glucocorticoids were the risk factors for the prognosis.CONCLUSION The mortality rate of the ICU patients with Candida bloodstream infection is high.It is necessary for the hospital to carry out the blood culture for the patients as early as possible and enhance the management of drugs and clinical nursing so as to reduce the risk of Candida bloodstream infection and improve the prognosis of the patients.

关 键 词：假丝酵母血流感染 重症监护室 临床特征 预后 

分 类 号：R379.4[医药卫生—病原生物学]