定植指数对于监测EICU患者发生侵袭性假丝酵母菌感染的临床意义

Clinical significance of colonization index for monitoring invasive candidiasis infection in EICU

目的·分析定植指数(CI)对监测急诊重症监护病房(EICU)患者发生侵袭性假丝酵母菌(IC)感染的临床意义。方法·收集2014年2月一2015年1月间入住EICU的患者标本,包括痰液(或咽拭子)、粪便(或肛周拭子)、中段尿、皮肤拭子和其他类型标本,通过科玛嘉假丝酵母菌显色培养基进行培养、分离和初步菌种鉴定,使用ITS1/ITS4引物扩增内转录间隔区(ITS)的基因片段并测序,进行进一步的菌种鉴定;同时,收集患者的临床信息,分析CI对监测IC发生的临床意义。结果·纳入研究的11 1例患者中有9例发生了IC,其中8例在感染前已有假丝酵母菌定植。CI≥0.5组与0<CI<0.5组和CI=0组的患者相比,其IC的发生率、患者死亡率及脓毒血症的发生率均明显升高。结论·EICU患者发生IC与假丝酵母菌定植有关,可用CI来反映患者假丝酵母菌的定植情况,且CI≥0.5组的患者更易发生IC感染。抗真菌药物及一些侵袭性操作(中心静脉导管穿刺、机械通气、肾脏替代疗法、手术)均是影响假丝酵母菌定植和感染的危险因素。

Objective · To analyze the clinical significance of colonization index （CI） for patients in emergency intensive care unit （EICU） to develop invasive candidiasis （IC） infection. Methods · Samples from patients admitted in EICU from February 2014 to January 2015 were collected, including sputum （or throat swabs）, stool （or rectal swabs）, midstream urine, skin swabs, and other samples. Samples were cultured with CHROMagar Candida chromagenic medium and Candida was isolated and primarily identified. Then detailed identification was performed by amplifying and sequencing the internal transcribed spacer （ITS） regions using the ITS1/ITS4 primers. Meanwhile, the clinical information of the patients was collected and the clinical significance of CI on monitoring the incidence of IC was analyzed. Results · A total of 111 patients were enrolled. Nine were infected with IC and 8 of them had Candida colonization before infection. The CI ≥0.5 group had significantly higher incidence of IC, mortality, and incidence of pyemia compared with the 0〈CI〈0.5 and CI=0 groups. Conclusion · The incidence of IC in patients in EICU is associated with the Candida colonization. CI can be used to reflect the Candida colonization in patients. Patients with CI ≥0.5 are more likely to have IC infection. Antifungal drugs and some invasive medical procedures such as central venous catheter （CVC） puncture, mechanical ventilation, renal replacement therapy, and surgeries are all risk factors for influencing Candida colonization and infection.