医院内真菌性败血症发生的危险因素研究

Risk Factors for Patients with Fungal Septicemia

目的为了解国内真菌性败血症的流性病学特征及其发生的危险因素。方法采用病例对照研究的方法 ,回顾性分析了医院2005-2008年住院患者真菌性败血症的发病情况。结果共40例患者发生真菌性败血症,发生率为4.76/10 000,多为高龄患者,平均年龄（64±16.54）岁,男性（82.5%）多于女性（17.5%）,内科患者多见（67.5%）,多发生于ICU（57.5%）,恶性肿瘤患者多发（32.5%）;假丝酵母菌属是常见的致病菌,其中最常见的为热带假丝酵母菌（30.0%）,其次为白色假丝酵母菌（25.0%）;继发真菌性败血症的危险因素为深静脉置管、肠外营养、长时间使用碳青酶烯类抗菌药物,入住ICU,其中长时间使用碳青酶烯类抗菌药物、肠外营养是独立的危险因素。结论真菌性败血症预后差,避免滥用碳青酶烯类抗菌药物,有助于减少真菌性败血症的发生。

OBJECTIVE To identify the risk factors for patients with fungal septicaemia and the factors for death.by analyzeing demographic,clinical,and microbiological data.METHODS A time-matched case-control study was developed to identify the risk factors for 40 patients with fungal septicemia.Two control patients without fungal septicemia were matched with each patient.A conditional linear logistic regression analysis was used to identify the possible risk factors,including age,neutropenia,deep venous catheterization,urinary catheterization,long-term use of broad-spectrum antibiotics,trauma,steroid/cytotoxic chemotherapy,malignant disease,ICU stay,parenteral nutrition,hemodialysis,hyperglycemia,and mechanical ventilation.RESULTS From 40 cases with fungal septicemia the incidence was 4.76 per 10000 hospital admissions.The most of them were the elderly patients with mean age of 64±16.54.Males were more prevalent than females（males vs females were 33∶7）.The internal medicine patients（67.5%）,cancer patients（32.5%） and patients in ICU（57.5%） were the most.The main pathogen species were Candida spp.Overall,C.tropicalis accounted for the majority of episodes（12,30%）,followed by C.albican（10,25%）.The major risk factors for fungemia were parenteral nutrition,long-term use of broad-spectrum antibiotics（ie carbapenems）,ICU stay,and deep venous catheterization.The former two factors were,whose which odd ratio a 3.85 and 7.28,95% CI were 1.55-9.56 and 2.95-17.9,respectively.CONCLUSIONS The prognosis of fungal septicemia is not fine.Avoiding the abuse use of carbapenems may reduce the risk of fungal septicemia.