ICU患者侵袭性念珠菌病的临床特征、耐药性及预后分析  

Clinical characteristics,drug resistance and prognostic analysis of invasive candidiasis in ICU patients

作　　者：周海春 邹星宇 王俊文 郭云云 ZHOU Haichun;ZOU Xingyu;WANG Junwen;GUO Yunyun(Jieshou City Traditional Chinese Medicine Hospital Intensive Care Unit,Jieshou 236500,China)

机构地区：[1]界首市中医院重症医学科,界首236500

出　　处：《中国真菌学杂志》2025年第1期39-44,51,共7页Chinese Journal of Mycology

摘　　要：目的 探讨ICU患者侵袭性念珠菌病(invasive candidiasis,IC)的临床特征、耐药性及预后分析。方法 回顾性分析2020年10月—2024年9月我院ICU收治的持续发热患者356例,按照是否继发IC分为IC组(n=89)和非IC组(n=267),统计检出念珠菌的菌种分布和耐药性情况,统计两组预后情况和临床结局。结果 IC组89例中共检出念珠菌97株,占比最高为白念珠菌44株(45.36%),检出真菌最多的标本为尿液。进行药敏试验的97株念珠菌中热带念珠菌耐药情况最严重(46.15%),菌株总体对伊曲康唑耐药性最高18株(18.56%),对卡泊芬净最低(0.00%)。IC组的ICU停留时长和呼吸机使用时长显著高于非IC组(P <0.05),收入和离开ICU时的生活能力评分差值显著高于非IC组(P <0.05);生存率显著低于非IC组(P <0.05)。Pearson相关性显示:ICU患者发生IC与ICU停留时长和呼吸机使用时长呈显著正相关(P <0.05),与生活能力评分差值呈显著负相关(P<0.05)。结论 ICU患者继发IC后检出真菌中白念珠菌最多,送检标本中尿液检出的真菌株最多。热带念珠菌耐药性最高,伊曲康唑的总体耐药率最高,卡泊芬净的总体敏感度最好。ICU继发IC患者预后情况和临床结局相对更差。Objective To investigate the clinical characteristics,drug resistance,and prognostic analysis of invasive candidiasis(IC)in intensive care unit(ICU)patients.Methods A retrospective analysis was conducted on 356 patients with persistent fever admitted to the ICU of our hospital from October 2020 to September 2024.Patients were divided into two groups based on whether they developed IC:the IC group(n=89)and the non-IC group(n=267).The distribution of Candida species and their drug resistance were statistically analyzed,as well as the outcomes and clinical endpoints of the two groups.Results Among the 89 cases in the IC group,97 strains of Candida were identified,with the highest proportion being C.albicans(44 strains,45.36%),and the most common specimen for fungal isolation was urine.Among the 97 strains of Candida underwent susceptibility testing,C.tropicalis showed the most severe drug resistance(46.15%),with the highest overall resistance to itraconazole(18 strains,18.56%),and the lowest resistance to caspofungin(0.00%).The duration of ICU stay and mechanical ventilation use in the IC group were significantly higher than those in the non-IC group(P<0.05),and the difference in the activity of daily living(ADL)scores at admission and discharge from the ICU was significantly higher in the IC group(P<0.05);the survival rate was significantly lower in the IC group(P<0.05).Pearson correlation analysis showed that IC in ICU patients was significantly positively correlated with the duration of ICU stay and mechanical ventilation use(P<0.05),and significantly negatively correlated with the difference in ADL scores(P<0.05).Conclusion In ICU patients who developed secondary IC,C.albicans was the most frequently isolated fungus,and urine was the specimen with the highest detection rate of fungal strains.C.tropicalis showed the highest antifungal resistance,with the highest resistance to itraconazole,and the best sensitivity to caspofungin.The prognosis and clinical outcomes of ICU patients with secondary IC were relatively

关 键 词：侵袭性念珠菌病 重症监护室 菌种分布 耐药性 预后 

分 类 号：R519.3[医药卫生—内科学]