获得性免疫缺陷综合征合并败血症患者的病原谱分析

Pathogen spectrum of sepsis patients with acquired immune deficiency syndrome

目的分析本地区获得性免疫缺陷综合征(AIDS)合并败血症患者的病原谱分布以及与CD4^+T淋巴细胞水平的相关性。方法回顾性分析2014年1月至2015年12月武汉大学中南医院收治的AIDS合并败血症患者的住院病历资料,总结病原微生物分布比例,分析病原微生物谱与CD4^+T细胞的相关性。结果 84例AIDS合并败血症患者中,培养结果为细菌感染者38例(占45.3%),真菌感染者39例(占46.4%),混合感染者7例(占8.3%);其中混合感染者均为细菌和真菌二重感染。标本中共分离出91株微生物,最常见的微生物分别为马尼尔菲青霉菌24株(占26.4%)、新型隐球菌21株(占23.1%)、人葡萄球菌9株(占9.9%)和屎肠球菌7株(占7.7%)。83例成人患者中,CD4^+T细胞>100个/μl者14例(占16.9%),均为细菌感染;51~100个/μl者5例(占6.0%);CD4^+T细胞≤50个/μl者64例(占77.1%),以真菌和混合感染为主(占67.2%)。CD4^+T细胞≤50个/μl的AIDS合并败血症患者真菌和混合感染败血症的风险显著高于CD4^+T细胞>50个/μl者,差异具有统计学意义(OR=6.63;χ~2=15.67,P<0.001)。结论 CD4^+T细胞≤50个/μl的AIDS患者为真菌败血症和混合感染败血症的高危人群,本地区应重视AIDS合并马尼尔菲青霉菌和新型隐球菌败血症,须高度重视并注意消毒隔离,避免住院AIDS患者发生院内感染。

Objective To investigate the pathogen spectrum of patients with acquired immune deficiency syndrome （AIDS） complicated with septicemia in local area. Methods The clinical data of AIDS patients complicated with septicemia in Zhongnan Hospital of Wuhan University from January 2014 to December 2015 were analyzed, retrospectively; the distribution of pathogenic microorganisms were investigated and the correlation between pathogenic spectrum and CD4＋ T cell counts were analyzed. Results Among the 84 AIDS patients complicated with septicemia, 38 cases （45.3%） were with bacterial infection, 39 cases （46.4%） withfungal infection, 7 cases （8.3%） with bacterial and fungal co-infection. Total of 91 strains of pathogenic microorganism were collected, predominated by 24 strains （26.4%） of Penicillium marneffei, 21 strains （23.1%） of Cryptococcus neoformans, 9 strains （9.9%） of Staphylococcus hominis and 7 21 strains （7.7%） of Enterococcusfaecium. Among the 83 adult patients, 14 patients （16.9%） werefungal infection with CD4＋ T cell counts 〉 100 cells/μl; 5 patients with CD4＋ T cell counts of 51-100 cells/μl There were 64 patients （77.1%） whose CD4＋ T cell ≤ 100 cells/μl, mainly with bacterial andfungal co-infection （67.2%）. The risk of septicemia with fungi and co-infection in AIDS patients with CD4＋ T cell ≤ 50 cells/μl was significantly higher than that of patients with CD4＋ T cell 〉 50 cells/μl, with significant difference （OR = 6.63, x^2 = 15.67, P 〈 0.001）. Conclusions AIDS patients with CD4＋ T cell ≤ 50 cells/μl were high-risk groups for fungal septicemia and mixed infection sepsis, AIDS complicated with Penicillium marneffei and Cryptococcus neoformans sepsis in our region should be attached importance, and disinfection and isolation must be attached great importance to inorder to avoid the hospital infection of patients with AIDS.