念珠菌血症患者血培养菌株分离特点及预后分析  

Characterization of blood culture strain isolation and prognosis of patients with candidemia

作　　者：姜宁 郭丽洁[1] 褚云卓[1] JIANG Ning;GUO Lijie;CHU Yunzhuo(Department of Laboratory Medicine,The First Hospital of China Medical University,National Clinical Research Center for Laboratory Medicine,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院检验科,国家医学检验临床医学研究中心,沈阳110001

出　　处：《中国医科大学学报》2025年第3期219-222,227,共5页Journal of China Medical University

基　　金：国家重点研发计划子课题(2021YFC2300402)。

摘　　要：目的分析我院念珠菌血症患者的临床特点、药敏试验结果及预后相关危险因素,为念珠菌血症的临床合理用药及预后改善提供依据。方法选取2020年1月至2022年12月我院念珠菌血症患者181例。收集患者的基本资料、药敏试验结果、临床资料,根据患者疾病转归分为预后良好组及预后不良组,采用χ2检验及二元logistic回归分析患者的预后危险因素。结果共检出181株念珠菌,其中,近平滑念珠菌88株(48.62%),白念珠菌34株(18.78%)、热带念珠菌29株(16.02%)、光滑念珠菌17株(9.39%),主要分布在普外科(51.93%)、重症医学科(16.02%)和急诊科(9.94%)。logistic回归分析结果显示,长期应用激素和(或)免疫抑制剂(OR=4.787)、机械通气>96 h(OR=4.558)、肾功能不全(OR=4.426)、肺内感染(OR=4.228)是念珠菌血症患者预后的独立危险因素。结论我院念珠菌血症主要由近平滑念珠菌引起,除热带念珠菌对伏立康唑敏感性较低外,其余对唑类药物敏感性较高,激素和(或)免疫抑制剂的应用、机械通气>96 h、肾功能不全及肺内感染是念珠菌血症患者预后的独立危险因素。Objective To analyze the clinical characteristics,drug sensitivity,and prognostic risk factors of patients with candidemia at our hospital,for providing evidence for rational drug use and improving prognosis.Methods A total of 181 patients with candidemia who were admitted to our hospital between January 2020 and December 2022 were selected for this study.Basic data,drug susceptibility test results,and clinical information were collected and analyzed.Patients were divided into two groups:a favorable prognosis group and a poor prognosis group;their prognostic risk factors were analyzed using univariate and binary logistic analyses.Results Candidemia was diagnosed from 181 Candida strains,including Candida parapsilosis(88 strains,48.62%),Candida albicans(34 strains,18.78%),Candida tropicalis(29 strains,16.02%),and Candida glabrata(17 strains,9.39%).Patients with candidemia were mainly diagnosed during general surgery(51.93%),intensive care unit(16.02%),and emergency department(9.94%).Univariate and binary logistic analyses showed that use of hormone and(or)immunosuppressive agents(OR=4.787),mechanical ventilation for more than 96 h(OR=4.558),renal insufficiency(OR=4.426),and intrapulmonary infection(OR=4.228)were important independent risk factors.The highest detection rate of candidemia in our hospital was for Candida parapsilosis.With the exception of Candida tropicalis,which was less sensitive to voriconazole,all other strains were sensitive to azole drugs.In conclusion,hormone and(or)immunosuppressive agents,mechanical ventilation for more than 96 h,renal insufficiency,and intrapulmonary infection are independent risk factors for poor prognosis in patients with candidemia.

关 键 词：念珠菌血症 危险因素 药敏试验 预后 

分 类 号：R519.3[医药卫生—内科学]