重症监护病房念珠菌感染和危险因素分析

Study on the morbidity and pathogens of patients with candidemia at the intensive care unit

目的探讨重症监护病房（ICU）患者念珠菌菌血症患病现状、变化及病原菌分析。方法收集2002年4月至2007年3月浙江大学医学院附属第一医院ICU念珠菌菌血症患者临床资料，调查念珠菌菌血症的患病情况及病原菌，进行单因素Х^2检验及多因素logistic回归分析。结果5年间ICU出院6034人次，符合念珠菌菌血症的患者75例，年患病率0．67％、1.46％、1.21％、1.15％、1．56％。死亡36例，总病死率48％，年病死率50％、64％、33％、41％、52％。血培养标本分离出念珠菌78株，其中白色念珠菌36株（46．2％），光滑念珠菌17株（21.7％），热带念珠菌14株（17．9％），近平滑念珠菌10株（12．8％），葡萄牙念珠菌1株（1．3％）。APACHEⅡ评分9～27分，平均17．21分±4．38分。5年间念珠菌菌血症的患病率从0．67％上升到1．56％，非白色念珠菌菌血症患者的比例从50．0％上升至56.5％。绎过对白色念珠菌组和非白色念珠菌组各项特征的单因素及多因素logistic回归分析发现，年龄（66岁±14岁 vs ．53岁±16岁，P=0．001，OR=1．077，95％CI：1．031～1.124）、低蛋白血症（61．8％ vs．816％，P=0．033，OR=0．206，95％CI：0．048～0．880）差异有统计学意义。结论存ICU患者中念珠菌菌血症的患病率有上升趋势，病死率高，非白色念珠菌所致的念珠菌菌血症也有所上升，年龄是发生白色念珠菌感染独立的危险因素，低蛋白血症是非白色念珠菌感染独立的危险因素。

Objective To study the mortality and pathogens of candidemia in patients at hospital intensive care unit （ICU）. Methods Clinical data of candidemia cases admitted to ICU of the First Affiliated Hospital of Zhejiang University in recent five years were analyzed retrospectively. Chi-square test and logistic regression analysis were used. Results A total of 6034 patients were discharged in the ICU over the 5-year period, and 75 were diagnosed as candidemia. The annual morbidity rates of candidemia from 2002 to 2006 were 0.67%, 1.46%, 1.21% , 1.15% and 1.56%, respectively. 36 cases died of the disease, with the mortality as 48%. The annual mortality rates from 2002 to 2006 were 50%, 64%, 33%, 41% and 52%, respectively. In this period, 78 positive blood culture samples strains from ICU were identified as Candida, among which Candida albicans, C. glabrata , C. tropicalis, C. parapsilosis and C.lusizarziae accounted for 46.2%, 21.7%, 17.9%, 12.8% and 1.3%, respectively. Average APACHE Ⅱ scores of the patients with candidemia were 17.21 ±4.38 （range： 9-27）. During the 5-year period, the annual morbidity of candidemia had increased from 0.67% to 1.56% while the ratios of candidemia due to non-albicans Candida species （NAC） increased from 50.0 % to 56.5 %. When analyzing the C. albicans group and NAC group with single factor and multiple conditional logistic regression method, we found that age （66±14 vs. 53±16, P 0.001, OR 1.077, 95%CI： 1.031- 1.124） and hypoproteinemia （61.8% vs. 81.6% , P= 0.033, OR-0.206,95%CI：0.048-0.880） both showed statistical significance. Conclusion Candidemia cases in ICU increased gradually and causing higher mortality. The number of patients with candidemia caused by NAC increased in recent 5 year. Age was proved to be a risk factor for those candidemia caused by C. albicans. Hypoproteinemia was proved to be risk factors for the candidemia caused by NAC.