侵袭性念珠菌院内感染的流行病学调查

Epidemiological study of invasive nosocomial candidiasis in 2 teaching hospitals in Beijing

目的研究综合医院侵袭性念珠菌院内感染的流行病学特点。方法采用回顾性研究方法，连续收集2004年1月至2006年9月北京朝阳医院（CYH）和北京协和医院（PUMCH）诊断的侵袭性念珠菌院内感染资料，研究发生率和病死率，确定抗真菌治疗和预后的关系；采用微量肉汤稀释法判定念珠菌对常见抗真菌药物的体外敏感性。结果2家医院侵袭性念珠菌院内发生率逐年上升，CYH和PUMCH分别由2004年的0．053％和0．025％升高到2006年的0．074％和0．049％。菌血症是侵袭性念珠菌感染的主要类型（55．8％），其次是腹腔感染（26．0％）、胸腔感染（9．1％）和胆道感染（7．8％）。白念珠菌占院内侵袭性念珠菌感染的首位（57．1％），热带念珠菌第2位（19．5％），其次是光滑念珠菌（14．3％）和近平滑念珠菌（2．6％）。氟康唑对于白念珠菌、热带念珠菌、光滑念珠菌和近平滑念珠菌的敏感性分别为97．7％、86．7％、63．6％和100％；两性霉素B对不同念珠菌属的敏感性均为100％。侵袭性念珠菌感染粗病死率37．7％；其中43例念珠菌血症未接受抗真菌治疗者病死率为72．7％，接受抗真菌治疗者病死率37．5％，两组差异有统计学意义（P=0．043）。氟康唑的治愈率在PUMCH为63．6％，在CYH为52．6％。结论侵袭性念珠菌院内感染在大型综合医院发生率逐渐上升，病死率高，应该不断加强侵袭性念珠菌感染的监测，努力提高合理应用抗真菌药物的水平。

Objective To investigate the epidemiological characteristics of invasive nosocomial candidiasis in teaching hospitals in Beijing. Methods The clinical data of consecutive cases diagnosed as with nosocomial candidiasis hospitalized in Beijing Chaoyang Hospital （ CYH ） （ n = 43 ） and Peking Union Medical College Hospital （PUMCH） （n = 34） from January 2004 to September 2006 were retrospectively analyzed to evaluate the incidence and mortality, and the relationship between antifungal therapy and outcomes. The minimum inhibitory concentrations （MICs） for Candida spp were determined by microdilution method. Results The incidence rates of nosocomial candidiasis of CYH and PUMCH were 0. 053% and 0. 025% respectively in 2004, and increased to 0. 074% and 0. 049% respectively in 2006. Candidemia accounted for 55. 8% （43/77） of the Candida infection, followed by intra-abdominal infection （26. 0%, n=20）, intra-thoracic infection （9. 1%, n =7）, and biliary tract infection （7. 8%, n =6）. The species mostly frequently isolated were Candida albicans （57. 1% ）, followed by C. tropicalis （ 19. 5% ）, C. glabrata （14. 3% ）, and C. parasilosis （2.6%）. The susceptibility rates of C. albicans, C. tropicalis, C. glabrata, and C. parasilosis to fluconazole were 97. 7%, 86. 7%, 63.6%, and 100% respectively. No isolates were resistant to amphotericin B. The crude mortality rate of Candida infection was 37. 7%. The mortality rate of the candidemia patients who did not receive systemic antifungal therapy was 72. 7%, significantly higher than those who received antifungal therapy （37.5%, P = 0. 043 ）. Most patients received fluconazole as the first choice （91.7% in PUMCH and 79. 2% in CYH） with the survival rates of 63.6% and 52. 6% respectively. Conclusion With high morbidity and mortality, invasive nosocomial candidiasis is a big problem in teaching hospitals. Further investigation is necessary to evaluate the incidence and to identify which antifungal agents are most protective for candidiasis.