念珠菌血流感染临床与实验室特点分析

Clinical and laboratory characteristics of Candida bloodstream infection

目的根据血培养真菌阳性标本,进行病原学与药敏试验分析,探讨念珠菌在血流感染中的临床和实验室特点。方法收集某院2012年6月至2018年9月的血培养结果为真菌的临床资料,对真菌种类、阳性报警时间(TTP)、标本送检科室、病原菌来源和氟康唑药敏试验结果进行分析。结果血培养分离出真菌共86株,非重复分离株为50株,44株为念珠菌属。排在前3位的念珠菌分别为白念珠菌18株(40.91%),近平滑念珠菌和光滑念珠菌各10株各占(22.73%);近平滑念珠菌TTP[(56.14±7.22)h]最长,热带念珠菌TTP[(19.36±1.24)h]最短,白念珠菌[(34.67±2.98)h]与光滑念珠菌[(38.16±4.12)h]TTP接近居中;念珠菌血症前3位科室为神经外科10株(22.73%)、肿瘤血液科6株(13.64%)、重症监护病房5株(11.36%);泌尿系统为最常见感染来源,其次为腹腔引流感染和导管相关感染;近平滑念珠菌、热带念珠菌对氟康唑敏感率均为100%,白念珠菌和光滑念珠菌分别为88.89%和70%,克柔酵母菌和酿酒酵母菌各1株为耐药和敏感。结论本院念珠菌血流感染最常见为白念珠菌,其次为近平滑念珠菌和光滑念珠菌。如果血培养需氧瓶阳性且TTP大于40 h,发生念珠菌血流感染的可能较大,临床或实验室应高度重视。泌尿系感染、导管相关血流感染、手术部位感染是念珠菌血症的重要感染源。大部分念珠菌对氟康唑仍敏感。

Objective To analyze the pathogenicity and drug susceptibility test based on blood culture fungal positive specimens, and to explore the clinical and laboratory characteristics of Candida in bloodstream infection. Methods The clinical data of blood culture were collected from June 2012 to September 2018 in our hospital. The fungal species, positive alarm time (TTP), specimen delivery department, pathogen source and fluconazole susceptibility test results were analyzed. Results Eighty-six strains of fungi were isolated from blood culture, 50 strains were non-repetitive isolates, and 44 strains were Candida spp. The top three Candida species were Candida albicans with 18 strains(40.91%), Candida parapsilosis and Candida glabrata with 10 strains respectively (22.73%);and Candida parapsilosis TTP [(56.14±7.22)h] is the longest, Candida tropicalis TTP [(19.36 ± 1.24) h] is the shortest, Candida albicans [(34.67 ± 2.98) h] and Candida glabrata [(38.16 ± 4.12) h] TTP in the middle;The top three departments of candidiasis was neurosurgery with 10 strains (22.73%), tumor hematology with 6 strains (13.64%), and intensive care unit with 5 strains (11.36%);urinary system was the most common source of infection, followed by abdominal drainage infection and catheter infection;Candida and Candida tropicalis were sensitive to fluconazole at 100%, Candida albicans and Candida glabrata were 88.89% and 70%, respectively, one strain of C.kruseii was resistant and one strain of Saccharomyces cerevisiae was sensitive. Conclusion The most common bloodstream infection of Candida in hospital is Candida albicans , followed by Candida parapsilosis and Candida .glabrata . If the blood culture aerobic bottle is positive and the TTP is greater than 40h, the incidence of Candida bloodstream infection may be high. Clinical and laboratory studies should be highly valued. Urinary tract infections, catheter-related bloodstream infections, and surgical site infections are important sources of infection for candidemia . Most of Candida is sensitive to fluconazole.