念珠菌血症合并细菌血流感染的临床与危险因素分析

Candidemia combined with bacterial bloodstream infection： analysis of clinical features and associated risk factors

目的 回顾性分析念珠菌血症合并细菌血流感染的临床资料,探讨其临床特点及相关危险因素.方法 分析自2009年1月至2011年12月入住北京同仁医院并经血培养证实为念珠菌血症合并细菌血流感染病例的临床特征、微生物学检查及临床结局等,与同期收治的单一念珠菌血症病例进行对照分析,并应用logistic回归探讨相关危险因素.结果 共收集念珠菌血症患者42例,其中念珠菌血症合并细菌血流感染组14例,单一念珠菌血症组28例.14例念珠菌血症合并细菌血流感染患者中革兰阳性球菌感染者10例,革兰阴性杆菌感染者4例,白色念珠菌6例,光滑念珠菌4例,热带念珠菌3例,克柔念珠菌1例.单一念珠菌血症组28例中白色念珠菌12例,光滑念珠菌4例,热带念珠菌2例,克柔念珠菌1例,两组相比差异无达统计学意义（P值分别为1.000、0.266、0.178和0.608）；但单一念珠菌血症组近平滑念珠菌感染者9例,念珠菌血症合并细菌血流感染组未检出.念珠菌血症合并细菌血流感染组12例出现脓毒性休克,单一念珠菌血症组为7例,差异有统计学意义（P=0.000）；前者死亡10例,后者死亡15例.单因素分析结果显示,住院时间超过4周（P=0.001）、念珠菌血流感染前是否存在菌血症（P=0.005）、是否存在血液系统肿瘤（P=0.01）、是否存在腹腔感染（P=0.001）为念珠菌血症合并细菌血流感染的危险因素,但多因素回归分析显示仅住院时间超过4周为独立危险因素.结论 念珠菌血症合并细菌血流感染以革兰阳性球菌为主,易并发脓毒性休克；住院时间超过4周为念珠菌血症合并细菌血流感染的独立危险因素.

Objective To investigate the clinical characteristics of and risk factors for candidemia combined with bacterial bloodstream infection （BSI） by retrospective analysis of cases.Method The clinical data of cases diagnosed as candidemia combined with BSI confirmed by blood culture were compared with those of cases with mono-candidemia in Beiing Tongren Hospital from January 2009 to December 2011.A logistic regression analysis was performed to investigate the independent risk factors.Results Forty-two cases diagnosed as candidemia were analyzed including 14 cases of candidemia combined with BSI and 28 cases of mono-candidemia.Ten strains of gram-positive cocci and 4 strains of gram-negative bacilli were isolated from candidemia combined with BSI group.Six strains of C.albicans,4 strains of C.glabrata,3 strains of C.tropicalis and 1 strain of C.krosei were isolated.There was no C.parapsilosis isolated from candidemia combined with BSI group but 9 strains in the mono-candidemia group.The septic shock rate of the candidemia combined with BSI group was higher than that of the mono-candidemia group （12/14 vs 7/28,P =0.000）.The mortality rate of the candidemia combined with BSI group was higher than that of the mono-candidemia group （10/14 vs 15/28）,but the difference did not reach statistical significance （P =0.266）.Four factors were found statistically different by univariate analysis,including hospitalization more than 4 weeks （P =0.001）,bacteremia before candidemia（P =0.005）,hematological tumor （P =0.01） and abdominal infection （P =0.001）.Multivariate analysis showed that hospitalization more than 4 weeks was the independent risk factor.Conclusion Gram-positive cocci were the predominant species and septic shock was more common in candidemia combined with BSI.Hospitalization more than 4 weeks was the independent risk factor for candidemia combined with BSI.