2014-2016年住院患者真菌感染的流行病学特点及相关因素分析

The epidemiological characteristics of fungal infections in inpatients from 2014-2016 and an analysis of related factors

目的研究住院患者感染真菌的流行病学特点及影响因素,为真菌感染的控制提供指导。方法2014-2016年1 725例住院患者的临床资料及送检标本,分离鉴定真菌,描述和分析真菌感染情况及相关因素。结果1 725例患者标本中共分离真菌406株,其中2014年74株,2015年217株,2016年115株;菌种分别为:白色假丝酵母菌173株(42.61%),光滑假丝酵母菌116株(28.57%),热带假丝酵母菌77株(18.97%),近平滑假丝酵母菌40株(9.85%)。分离真菌的主要科室来源:ICU 239株(58.87%),肾脏病科64株(15.76%),神经外科36株(8.87%),心血管外科20株(4.93%),肝胆外科12株(2.96%),其他科室35株(8.62%)。真菌标本来源:尿液309株(76.11%),血液33株(8.13%),分泌物31株(7.64%),引流液13株(3.20%),穿刺液6株(1.48%),胸透液6株(1.48%),其他标本8株(1.97%)。住院时间、基础疾病种类、联合使用抗菌药物情况与患者真菌感染有相关性,真菌感染与性别无关。结论2014-2016年住院患者感染的主要真菌类型主要为白色假丝酵母菌,主要来源于ICU,以尿液为主,真菌感染以泌尿道感染为多见,且真菌感染发生与患者住院时间较长、基础疾病种类以及治疗中联合使用抗菌药物相关。

Objective To examine the epidemiological features of fungal infections in inpatients in order to guide the control of fungal infections. Methods Clinical data and laboratory samples were collected from 1 725 inpatients from 2014--2016, and fungi were isolated and identified. The status of fungal infection and related factors were described and analyzed. Results Four hundred and six strains of fungi were isolated from 1 725 patient samples, including 74 strains isolated in 2014, 217 isolated in 2015, and 115 isolated in 2016. Fungi included 173 strains （42.61%） of Candida albi- cans, 116 strains （28.57%） of C. glabrata, 77 strains （18.97%） of C. tropicalis, and 40 strains （9.85%） of C. pa- rapsilosis. Two hundred and thirty-nine strains of fungi were isolated from the ICU （58.87%）, 64 were isolated from Nephrology （15.76%）, 36 were isolated from Neurosurgery （8. 87%）, 20 were isolated from Cardiovascular Surgery （4.93%）, 12 were isolated from Liver and Gallbladder Surgery （2.96%）, and 35 were isolated from other departments （8.62 %）. Three hundred and nine strains of fungi （76.11%） were isolated from urine samples, 33 （8.13 %） were isola- ted from blood, 31 （4. 05%） were isolated from secretions, 13 （3.20%） were isolated from drainage fluid, 6 （1.48%） were isolated from aspirated fluid, 6 （1.48%） were isolated from pleural liquid, and 8 （1.97%） were isolated from other samples. The duration of hospitalization, the patient＇s underlying disease, and combined use of antimicrobials were associ- ated with a fungal infection, but a fungal infection was not associated with gender. Conclusion The main type of fun- gus infecting inpatients from 2014--2016 was C. a lbicans, and infections primarily originated from the ICU. Strains of fungi were mainly isolated from urine samples, and a urinary tract infection was common in patients with a fungal infec- tion. The development of a fungal infection was related to a longer duration of hospitalization, the patient＇s underlying dis- ease, and the combined use of antimicrobials.