82例念珠菌血症患者的临床分析

Clinical analysis of 82 patients with candidemia

目的探讨念珠菌血症患者的病原体分布、基础疾病、危险因素及治疗预后。方法回顾性分析首都医科大学宣武医院2013年1月至2016年12月间念珠菌血症患者的临床资料。结果 82例念珠菌血症患者中,白念珠菌感染者占42.7%,非白念珠菌感染者占57.3%,其中近平滑念珠菌感染者22.0%,热带念珠菌感染者19.5%;大多临床分离菌株体外对抗真菌药物敏感。入组患者主要基础疾病有肺部疾病(45.1%)、糖尿病(37.8%)和肿瘤(34.1%)。常见危险因素包括长期使用广谱抗菌药物(92.7%)、侵入性导管(87.8%)和肠外营养支持(81.7%)。30 d病死率为29.3%,年龄、感染性休克和合并细菌血流感染为30 d死亡的独立影响因素。结论念珠菌血症病原菌以非白念珠菌为主,大多数临床分离菌株体外对抗真菌药物敏感,患者常合并严重基础疾病,伴有多种危险因素,预后较差。临床上应早期识别高危患者,抢先治疗以改善患者预后。

Objective To investigate the Candida species distribution,underlying diseases,risk factors and treatment outcome in patients with candidemia.Methods Clinical data of the patients with candidemia in Xuanwu Hospital,Capital Medical University from January2013to December2016were analyzed,retrospectively.Results Total of82episodes of Candidemia was identified.The proportion of candidemia caused by C.albicans and non-albicans species were42.7%and57.3%,which included C.parapsilosis(22.0%)and C.tropicalis(19.5%).The majority of the isolates were susceptible to anti-fungal agents in vitro.Pulmonary diseases(45.1%),diabetes mellitus(37.8%)and tumor(34.1%)were the main predisposing diseases.Broad-spectrum antibiotic use(92.7%),invasive catheter(87.8%)and parenteral alimentation(81.7%)were the major risk factors.The overall30-day mortality was29.3%.Age,septic shock and bacterial bloodstream infection were independent risk factors for30-day mortality.Conclusions Nonalbicans Candida was predominant in candidemia.Most clinical strains were sensitive to antifugal drugs in vitro.Patients were accompanied by a variety of risk factors,had severe underlying disease and poor prognosis.High-risk patients should be identified early clinically in order to treat timely and improve the prognosis.