30例真菌性败血症的临床分析

Clinical Analysis of 30 Patients with Fungal Septicemia

目的探讨真菌性败血症的病原体分布、基础疾病、危险因素以及防治策略。方法采用病例对照研究的方法回顾性分析中南大学湘雅医院2011年4月至2012年11月30例住院患者真菌性败血症的临床特点。结果 30例患者中,前3位病原体依次为白色假丝酵母菌、热带假丝酵母菌和近光滑假丝酵母菌,所占比例分别为43.3%、23.3%和10.0%。30例患者均为医院内感染,主要基础疾病为血液系统恶性疾病、慢性阻塞性肺疾病(COPD)、糖尿病,所占比例分别为33.3%、23.3%和20.0%。最常见的危险因素为长期使用广谱抗生素(86.7%)、深静脉置管(60.0%)、肠外营养(53.3%)。30例患者均接受抗真菌治疗,3例(43.3%)痊愈或者好转,17例(56.7%)死亡,两性霉素B治疗的有效率高于氟康唑(P=0.002)、伏立康唑(P=0.006)。结论真菌性败血症病原菌以白色假丝酵母菌多见,血液系统疾病、COPD为主要基础疾病,长期使用广谱抗生素、肠外营养是其独立危险因素,生存患者多为接受两性霉素B治疗者。临床上及时去除危险因素,早期经验性治疗是降低病死率的关键。

Objective To investigate the fungal species distribution, liability factors, therapy and prevention of fungal septicemia. Methods A time-matched case-control study was conducted in 30 patients from April 2011 to November 2012 with fungal septicemia. Results Of the pathogens in 30 cases with fungal septicemia, 43.3% was Candida albicans, 23.3% was Candida tropicalis, and 10% was Candida parapsilosis. All 30 cases with fungal septicemia were hospital acquired. Malignant hematological system disease（ 33.3% ）, COPD （ 23.3% ）, and diabetes （ 20. 0% ） were the main predisposing diseases. Broad spectrum antibiotic use （ 86. 7 % ）, endovascular prosthesis （60. 0% ）, parenteral alimentation （ 53.3 % ） were the major risk factors. All 30 cases received systemic anti-fugal therapy. The efficacy rate of amphotericin B therapy was higher than that of fluconazol （ P = O. 002 ） and voriconazole （ P = 0. 006）. 13 cases （43. 3% ） were cured or significantly improved,and 17 cases（56. 7% ） were dead. Conclusions The most frequently fungi was Candida albicans in fungal septicemia. Malignant hematological system disease and COPD were main predisposing diseases. Broad-spectrum antibiotic use and parenteral alimentation were independent risk factors. Anti-fugal therapy with amphotericin B can achieve better prognosis. Early diagnosis, controlling risk factors, and earlier empirical antifungal therapy are keys to reduce mortality of fungal septicemia.