ICU院内假丝酵母菌血症的临床特点及预后的多因素分析

Nosocomial Candidemia among Patients in Intensive Care Unit and Its Clinical Characteristics and Prognosis:A Multivariate analysis

目的探讨ICU院内假丝酵母菌血症的临床特点及影响预后的因素。方法收集2001-2008年医院ICU院内获得性假丝酵母菌血症107例进行回顾性分析,根据预后分为死亡组和生存组,运用多因素logistic回归分析来研究假丝酵母菌血症临床和主要生化指标与预后的关系。结果 107例患者血培养共分离出110株假丝酵母菌属,非白色假丝酵母菌比例高达70.91%,氟康唑对非白色假丝酵母菌敏感率低,死亡率43.52%;多因素logistic回归分析显示,出现感染性休克,合并细菌血症,升高的血清肌酐及SOFA评分>10分,MODS评分>9分是死亡的独立危险因素。结论 ICU院内获得性假丝酵母菌血症致病菌株以非白色假丝酵母菌为主,对氟康唑的耐药性增加,死亡率高,加强对上述危险因素的监测及真菌药敏监测,及时、合理使用抗真菌药物治疗可以改善假丝酵母菌血症的预后。

OBJECTIVE To study the clinical characteristics and prognostic factors of patients with nosocomial candidemia in intensive care unit.METHODS A retrospective study was carried out in 107 patients with nosocomial candidemia.A multivariate Logistic regression analysis was performed to find the correlations among the prognosis,and clinical and biochemical parameters.RESULTS A total of 110 candida strains were isolated from blood.The proportion of non-albicans species reached to 70.91%.The resistant candidiasis was increased.The drug sensitive rate of non-albicans candidemia to fluconazole was low and the over all,mortality rate was 43.52%.A multivariate Logistic regression analysis showed that septic shock,complicated bacteremia,higher serum creatinine,SOFA score more than 10,and MODS score more than 9 were the independent risk factors of hospital mortality.CONCLUSIONS Nosocomial candidemia in intensive care unit leads a high mortality,the drug resistance of non-albicans candidemia to fluconazole is increased.Strengthening the monitoring of the risk factors and early appropriate antifungal treatment may improve the prognosis.