老年病房院内真菌性尿路感染的临床特征分析

Clinical characteristics of nosocomial fungal urinary tract infection in geriatric wards

目的探讨近年来老年病房院内真菌性尿路感染（NFUTI）的危险因素及病原学特点。方法将广东省人民医院老年病房2009年1月至2014年12月收治的1122例院内尿路感染（NUTI）的患者分为NFUTI与非NFUTI患者，并对两组患者尿路感染情况进行分析。结果两组重症监护室（ICU）患者数、感染前留置尿管患者数、感染前使用抗生素患者数、患者血红蛋白水平及白蛋白水平比较，差异均有统计学意义（P〈0．05）。多因素回归分析显示，ICU患者数、感染前使用抗生素及较低的白蛋白水平是老年患者NFUTI的危险因素。在NFUTI中，常见的真菌依次是白色念珠菌、光滑球拟酵母菌、热带念珠菌、近平滑念珠菌及无名假丝酵母菌。ICU患者真菌感染及非白色念珠菌感染的比例均明显高于非ICU患者（均P〈0．05）。结论在老年病房中，有效的ICU感染监控措施、严格掌握抗生素使用指征及加强营养支持可能有助于减少NFUTI的发生。ICU中，真菌尤其是非白色念珠菌的检出率明显增高，临床医师应加以重视。

Objective To explore the risk factors and pathogenic characteristics of nosocomial fungal urinary tract infection （NFUTI） in the geriatric wards. Methods All the 1 122 patients with urinary tract infection in our geriatric wards from January 2009 to December 2014 were enrolled in this study. According to the collected clinical data, they were divided into NFUTI and non-NFUTI groups. Their infectious conditions in the urinary tract were analyzed. Results There were significant differences in the serum levels of hemoglobin and albumin, the patient numbers of intensive care unit （ICU）, previous indwelling catheterization, and previous use of antibiotics between the NFUTI group and non-NFUTI group （P 〈 0.05）. Multivariate regression analysis showed ICU hospitalization, previous use of antibiotics, lower level of serum albumin were the risk factors for NFUTI. Among NFUTI, the common fungi isolated from the urine samples were Candida albicans, Candida glabrata, Candida tropicalis, Candida parapsilosis and Candida famata in order. The proportions of fungal infection and non-Candida albicans infection were significantly higher in the patients of ICU than those in non-ICU （both P 〈 0.05）. Conclusion In geriatric wards, effective surveillances in ICU, strictly following antibiotic indications and enhancing nutritional support may decrease the incidence of NFUTI. Fungi, especially non-Candida abicans, have a higher detection rate in ICU, which should be paid more attention by the clinicians.