重症脓毒症患者医院获得性真菌感染流行病学调查及其影响因素分析

Epidemiological investigation and logistic regression analysis of nosocomial fungal infection in severe sepsis patients

目的调查重症脓毒症患者医院获得性真菌感染流行病学特点,并对其影响因素进行Logistic回归分析。方法回顾性分析本院2008年1月至2016年1月收治的578例重症脓毒症患者的临床资料,调查流行病学特点,对医院获得性真菌感染的可能影响因素进行单因素分析和多因素Logistic回归分析。结果本组578例重症脓毒症患者,215例伴医院获得性真菌感染,感染率为37. 20%,感染部位多为肺部,真菌类型多为白色假丝酵母菌,患者预后较差,生存时间<90 d者占比为42. 33%(91/215)。感染组与未感染组年龄、住ICU时间、持续使用两种以上抗菌药物时间、是否使用呼吸机、激素、侵入性操作、急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)等方面差异有统计学意义(P <0. 05);危险因素中危险程度由高到低依次为住ICU时间≥100 h(OR=5. 697)、使用呼吸机(OR=5. 388)、侵入性操作(OR=4. 987)、年龄≥65岁(OR=4. 584)、持续使用两种抗生素> 7 d(OR=3. 287)、使用激素(OR=2. 141)。结论重症脓毒症伴医院获得性真菌感染位多见于肺部,且多为白色假丝酵母菌感染,预后较差,死亡率较高,住ICU时间≥100 h、使用呼吸机及激素、侵入性操作、年龄≥65岁、持续使用两种抗生素> 7 d是其危险因素,临床上应制定针对性的预防措施,以减少真菌感染。

Objective To investigate the epidemiological characteristics of nosocomial fungal infections in severe sepsis patients and analyze the influencing factors by logistic regression. Methods The clinical data of 578 patients with severe sepsis admitted to our hospital from January 2008 to January 2016 were retrospectively analyzed. The epidemiological characteristics were investigated. The possible influen- cing factors of nosocomial fungal infection were analyzed by univariate analysis and multivariate logistic regression analysis. Results Among 578 cases of severe sepsis, 215 cases were accompanied by nosocomial fungal infection （ infection rate 37.20% ）. The infection sites were mostly lungs and the fungal types were Candida albicans. The prognosis of the patients was poor. The survival time was less than 90 days, accounting for 42. 33% （91/215）. There were significant differences in age, length of stay in intensive care unit （ICU）, duration of more than two antibiotics, use of ventilators, hormones, invasive procedures, acute physiology and chronic health evaluation [[ （APACHE ]] ） score between the infected group and the uninfected group （P 〈0. 05） . The danger degree from high to low of the risk factors were ICU stay ≥100 h （ OR = 5.697）, use respirator （ OR = 5. 388）, invasive operation （ OR = 4. 987 ）, age≥65 years （ OR = 4. 584） , and continuous use of two antibiotics 〉7 d （OR =3. 287）, use steroid （OR =2. 141）. Conclusions Severe sepsis with hospital acquired fungal infection is more common in the lung, and most of them are Candida albicans infection, with poor prognosis and high mortality. ICU stay ≥ 100 h, use respirator and steroid, invasive operation, age ≥65 years, and continuous use of two antibiotics 〉 7d are risk factors. Specific preventive measures should be taken to reduce fungal infections.