回顾性分析2015—2021年我院念珠菌尿患者的临床特征及合并念珠菌血症的危险因素  

Retrospective anlaysis of clinical characteristics of patients with candidiuria from 2015 to 2021 and the risk factors for concomitant candidemia

作　　者：周娇 吴建国 肖天兵 黄余清 陈燕 熊杰 贾蓓[1] Zhou Jiao;Wu Jianguo;Xiao Tianbing;Huang Yuqing;Chen Yan;Xiong Jie;Jia Bei(Key Laboratory of Infectious and Parasitic Diseases in Chongqing,Department of Infectious Diseases,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016;Infectious Disease Department of Chongqing Fengjie People’s Hospital,Chongqing 404600)

机构地区：[1]重庆医科大学附属第一医院感染科,重庆市传染病寄生虫病学重点实验室,重庆400016 [2]重庆市奉节县人民医院感染科,重庆404600

出　　处：《中国抗生素杂志》2024年第10期1175-1182,共8页Chinese Journal of Antibiotics

基　　金：重庆市科卫联合医学科研项目(No.2019ZDXM029)。

摘　　要：目的分析念珠菌尿及合并念珠菌血症的危险因素、临床特点,并评估念珠菌的频率分布及耐药情况,为临床念珠菌尿的诊治提供参考。方法采用回顾性调查的研究方法,收集2015—2021年我院316例念珠菌尿患者的临床资料,进行分组分析。结果我院念珠菌尿主要为老年患者,平均年龄为(63.66±19.55)岁,主要分布于重症监护病房(ICU)(78.4%),以无症状患者为主(89.6%),非白念珠菌的分离率超过了白念珠菌(57.6%vs.42.4%)。3.8%的念珠菌血症主要发生在ICU。常规尿检显示酵母样细胞检出率超过70%,氟康唑耐药率超过10%。超过60%的患者接受了抗真菌治疗。念珠菌的多部位定植、免疫功能低下状态、脓毒性休克和气管插管是合并念珠菌血症的危险因素。采用受试者工作特征曲线(ROC曲线)评价念珠菌评分的诊断价值,ROC曲线下面积(AUROC)为0.834,最佳截断值为3.5分。结论医生需重视尿常规检测酵母样细胞阳性患者以及时去除诱因改善念珠菌尿的发生发展,临床上存在过度治疗念珠菌尿,合并念珠菌血症的危险因素包括免疫抑制及多部位定植,念珠菌评分>3.5分应考虑合并念珠菌血症的风险。Objective This study evaluated the risk factors and clinical features associated with candiduria and those complicated with candidemia,analyzed the distribution frequency and antifungal resistance patterns of Candida species,and provided clinical guidance for the diagnosis and treatment of candiduria.Methods The clinical data from 316 patients with candiduria admitted to our hospital between 2015 and 2021 was collected and analyzed using a retrospective study approach.Results Candiduria cases in our hospital were predominantly elderly patients with an average age of(63.66±19.55)years old,largely in the intensive care unit(ICU)(78.4%).The majority of the cases were asymptomatic(89.6%).Isolations of non-Candida albicans species exceeded those of Candida albicans(57.6%vs.42.4%).Candidemia was concomitant in 3.8%of cases,mainly in the ICU.Routine urine tests presented with a high rate of detection of yeast-like cells in excess of 70%,and the fluconazole resistance rate at our institution surpassed 10%.More than 60%of patients received antifungal therapy.Multiple-site colonization of Candida,immunocompromised state,septic shock,and tracheal intubation were risk factors for complications of candidemia.The diagnostic value of the Candida score for candidemia was evaluated using the receiver operating characteristic curve(ROC curve),with the area under the ROC curve(AUROC)equal to 0.834 and the cut-off value of 3.5 points.Conclusion Clinically,the urine routine test with yeast counting might be a convenient method for the emergence of candiduria,reminding clinicians to take corresponding strategies to reduce the occurrence of candiduria.The overtreatment of antifungals with candiduria warrants caution.The presence of multisite colonization and immunosuppression serve as risk factors for progression to candidemia in patients with candiduria.Candida scores>3.5 should be considered as a risk of concomitant candidemia.

关 键 词：念珠菌尿 念珠菌血症 危险因素 临床特征 

分 类 号：R519.3[医药卫生—内科学]