白念珠菌与非白念珠菌血流感染危险因素、抗菌药物应用及预后比较

Risk factors, antibiotics exposure and outcomes of patients with Candida albicans and non-Candida albicans bloodstream infection

目的 探讨白念珠菌血流感染（CABSI）和非白念珠菌血流感染（NABSI）患者的危险因素、抗菌药物应用和预后的差异.方法 回顾性分析2009年1月至2010年6月收治的56例CABSI和76例NASBI患者的临床资料,组间比较采用独立样本t检验和x 2检验,相关性分析采用多因素Logistic回归分析.结果 与CABSI患者相比,NABSI患者接受外科手术（38.2％比21.4％,x2=4.214,P＜0.05）和中心静脉置管（63.2％比41.1％,x2=6.328,P＜0.05）者较多,接受机械通气者较少（26.3％比44.6％,x2=4.820,P＜0.05）;先前接受抗真菌药物（40.8％比21.4％,x2=5.503,P＜0.05）和硝基咪唑类药物治疗者较多（23.7％比8.9％,x2=4.879,P＜0.05）,而接受β-内酰胺/β-内酰胺酶抑制剂复方制剂者较少（34.2％比51.8％,x2=4.098,P＜0.05）.多因素分析显示,先前接受硝基咪唑类药物（OR=1.276,95％CI为1.132～9.708）、抗真菌治疗（OR=1.902,95％CI为1.250～4.685）和中心静脉置管（OR=3.437,95％CI为1.269～17.323）是患者罹患NABSI的独立危险因素（均P＜0.05）.CABSI患者30 d病死率较NABSI患者明显升高（50.0％比31.6％,x2=4.583,P＜0.05）.结论 先前接受抗真菌药物、硝基咪唑类治疗和中心静脉置管与NABSI的发生有关.与NABSI相比,CABSI患者预后较差,应引起临床医师重视.

Objective To investigate the risk factors,antibiotics exposure and outcomes in hospitalized patients with Candida albicans （C.albicans） bloodstream infection （CABSI） and non-C.albicans bloodstream infection （NABSI）.Methods The clinical data of 56 patients with CABSI and 76 patients with NABSI from January 2009 to June 2010 were collected and reviewed.Two-sample t-test and chi-square test were used for statistical analysis.Risk factors of NABSI were evaluated by Logistic regression analysis.Results Compared to CABSI group,more patients in NABSI group received surgery operations （38.2% vs 21.4% ; x2 =4.214,P〈0.05）,central venous catheter （CVC） placement （63.2% vs 41.1% ; x2 =6.328,P〈0.05）,and less patients received mechanical ventilation （26.3% vs 44.6% ; x2 =4.820,P〈0.05）.And more patients with NABSI received antifungal agents （40.8% vs 21.4%; x2 =5.503,P〈0.05） and nitroimidazoles agents （23.7% vs 8.9%; x2 =4.879,P〈0.05） and less patients received β-lactam/β-lactamase inhibitors （34.2 % vs 51.8 % ; x2 =4.098,P〈0.05）.In multivariate analysis,independent risk factors of NABSI were prior nitroimidazoles agents （OR=1.276,95% CI：1.132-9.708）,antifungal agents therapy （OR =1.902,95% CI：1.250-4.685） and CVC placement （OR =3.437,95%CI..1.269-17.323）.Overall 30-day-mortality in patients with CABSI was higher than patients with NABSI （50.0% vs31.6%; x2=4.583,P〈0.05）.Conclusions Prior treatment of antifungal agents,nitroimidazoles agents and CVC placement are associated with the development of NABSI.Compared with NABSI,CABSI is associated with worse prognosis and should be treated with caution.