老年患者非呼吸道侵袭性真菌感染的流行病学及危险因素

Epidemiology and risk factors of invasive fungal infections in old patients for non-respiratory tract

目的 探讨老年住院患者非呼吸道侵袭性真菌感染的流行病学及危险因素.方法 采用病例对照方法 研究78例老年患者非呼吸道侵袭性真菌感染发生的危险因素.结果 从78例患者中共分离出真菌84株,其中念珠菌82株（97.62%,82/84）,曲霉菌2株（2.38%,2/84）;在念珠菌中,白念珠菌55株（67.07%,55/82）、光滑念珠菌13株（15.85%,13/82）、克柔念珠菌6株（7.32%,6/82）、热带念珠菌4株（4.88%,4/82）、近平滑念珠菌3株（3.66%,3/82）、葡萄牙念珠菌1株（1.22%,1/82）.年龄、病原菌检测时间、基础疾病、使用抗生素种类、使用免疫抑制剂是老年住院患者非呼吸道侵袭性真菌感染的独立危险因素.结论 老年患者非呼吸道侵袭性真菌感染仍以白念珠菌为主.早期诊治基础疾病、合理规范使用药物、适当缩短住院时间是预防老年患者非呼吸道侵袭性真菌感染的关键.

Objective To investigate the epidemiology and relevant risk factors of invasive fungal infection （IFI） in hospital old patients for non-respiratory tract. Methods Seventy-eight patients of IFI in non-respiratory tract were enrolled in this investigation. The incidence and risk factors of IFI were analyzed by prospective case-control study. Results In 78 old patients, 84 strains were isolated from different parts, and the most was Candida spp 82 strains （97.62%,82/84）, followed by Candida albicans 55 strains （67.07%,55/82）, Candida glabrata 13 strains （ 15.85%, 13/82）, Candida krusei 6 strains （7.32%, 6/82）, Candida tropicalis 4 strains （4.88% ,4/82）, Candida parapsilosis 3 strains （3.66% ,3/82）, Candida lusitaniae 1 strain （ 1.22%, 1/82）. Aspergillus 2 strains （2.38%,2/84）. Multivariate Logistic regression analysis showed that age, pathogen detection time, underlaying disease,glucocorticoids, immunosuppressants were the risk factors for IFI in non-respiratory tract. Conclusions Candida albicans is the main pathogens of Candida infections in old patients. To efficiently control the risk factors should be emphasized in old patients, including early diagnosis and treatment underlying diseases, appropriate use drugs, right to shorten hospital stay.