92例医院获得性念珠菌血症患者临床特点及危险因素分析

Analysis of clinical characteristics and risk factors for 92 cases of nosocomially acquired candidemia

目的探讨医院获得性念珠菌血症患者临床特点及影响其预后的危险因素。方法收集2012年1月至2014年12月安徽医科大学第一附属医院全部医院获得性念珠菌血症患者进行回顾性分析，采用单因素、多因素回归分析对念珠菌血症患者预后危险因素进行分析。结果共检出念珠菌血症患者92例。菌株主要为光滑念珠菌39株（42．4％），白念珠菌30株（32．6％），克柔念珠菌7株（7．6％），热带念珠菌5株（5．4％），近平滑念珠菌4株（4．4％），其他念珠菌7株（7．6％）。对抗真菌药物的敏感率依次为氟胞嘧啶（100．0％）、两性霉素B（98．9％）、伏立康唑（92．4％）、氟康唑（82．6％）、伊曲康唑（77．2％）。30d死亡与念珠菌血症直接相关的归因病死率为13．0％。Logistic多因素回归分析显示，留置深静脉置管（OR=4．833，95％CI：1．010～23．125，P=0．049）、机械通气（OR=6．075，95％CI：1．144～32．257，P=0．034）、接受血液透析（OR=8．367，95％CI：1．390～50．364，P=0．020）是其死亡独立危险因素。结论引起医院获得性念珠菌血症的病原体主要为光滑念珠菌、白念珠菌和克柔念珠菌，对伏立康唑、氟康唑、伊曲康唑均有不同程度的耐药。留置深静脉置管、机械通气及接受血液透析是死亡独立危险因素。

Objective To investigate the clinical features and prognostic factors of nosocomially acquired candidemia. Methods A retrospective analysis was conducted for hospitalized patients with nosocomial candidemia between January 2012 and December 2014 at the First Affiliated Hospital of Anhui Medical University. The univariate and multivariate Logistic regression analyses were used to determine the prognostic factors of candidemia. Results A total of 92 patients were diagnosed with nosocomially acquired candidemia. The most common pathogen was Candida glabrata （C. glabrata, 39/92, 42.4%）, followed by Candida aIbicans （C. albicans, 30/92, 32. 6%）, then Candida krusei （C. krusei, 7/92, 7. 6 % ） , Candida tropicalis （ C. tropicalis, 5/92, 5. 4%）, Candida parapsilosis （ C. parapsilosis, 4/92, 4.4%） and other Candida spp. （7/92, 7. 6%）. The sensitivity rates of Candida spp. strains against flucytosine, amphotericin B, voriconazole, fluconazole and itraconazol were 100. 0%, 98. 9%, 92.4%, 82.6% and 77.2%, respectively. The 30-day attributable case fatality rate was 13.0%（12/92）. Multivariate Logistic regression analyses indicated that presence of central venous catheter （OR= 4. 833, 95%CI： 1.010-23. 125, P=0. 049）, invasive mechanical ventilation （OR=6. 075, 95%CI： 1. 144- 32. 257, P=0.034）, and receiving hemodialysis （OR=8.367, 95%CI： 1.390-50.364, P=0.020） were factors independently correlated with increased mortality. Conclusions The pathogens causing nosocomially acquired candidemia are mainly C. glabrata, C. albicans and C. krusei. The drug susceptibility of Candida spp. varies among fluconazole, itraconazol voriconazole. The resistant rates of Candida spp. against voriconazole, fluconazole and itraconazol are different. The presence of central venous catheter, invasive mechanical ventilation and receiving hemodialysis are factors independently correlated with increased mortality.