医院获得性假丝酵母菌菌血症流行病学特征及其药物敏感性

Epidemiological characteristics and drug susceptibility of hospital-acquired candidemia

目的分析医院获得性假丝酵母菌菌血症患者的临床特征、病原菌种类及其耐药情况,探讨影响假丝酵母菌菌血症患者预后的危险因素。方法选取南方医科大学南方医院2008年1月1日—2018年12月31日血培养确诊为医院获得性假丝酵母菌菌血症病例,收集人口统计学资料及临床资料,根据患者预后分为生存组与死亡组,进行统计分析。结果共收集240例医院获得性假丝酵母菌菌血症患者资料,其中男性155例,女性85例,平均年龄(50.4±16.6)岁。血培养分离白假丝酵母菌90株(37.5%),近平滑假丝酵母菌63株(26.3%),热带假丝酵母菌53株(22.1%)。白假丝酵母菌和近平滑假丝酵母菌对唑类药物的敏感率>90%,克柔假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌对氟康唑的敏感率较低(分别为40.0%、59.3%、62.3%),热带假丝酵母菌和克柔假丝酵母菌对伊曲康唑的敏感率也偏低(分别为62.3%、60.0%)。多因素分析结果表明,器官衰竭(OR=5.872,P<0.001)、脓毒性休克(OR=3.313,P=0.005)为医院获得性假丝酵母菌菌血症患者死亡的独立危险因素。结论白假丝酵母菌是引起假丝酵母菌菌血症最常见的病原菌,且检出了耐氟康唑、氟胞嘧啶、伊曲康唑的假丝酵母菌。假丝酵母菌菌血症患者基础疾病多、病情重、病死率高,器官衰竭、脓毒性休克是其死亡的独立危险因素。

Objective To analyze the clinical characteristics,pathogenic species and drug resistance of patients with hospital-acquired candidemia(HAC),and explore risk factors affecting the prognosis of patients with candidemia.Methods HAC cases which were confirmed by blood culture in Nanfang Hospital of Nanfang Medical University between January 1,2008 and December 31,2018 were chosen,demographic and clinical data were collected,patients were divided into survival group and death group according to the prognosis,statistical analysis was performed.Results Clinical data of 240 patients with HAC were collected,including 155 males and 85 females,with an average age of(50.4±16.6)years.90 strains(37.5%)of Candida albicans(C.albicans),63 strains(26.3%)of C.parapsilosis and 53 strains(22.1%)of C.tropicalis were isolated from blood culture.Susceptibility rates of C.albicans and C.parapsilosis to azoles were more than 90%,susceptibility rates of C.krusei,C.glabrata and C.tropicalis to fluconazole were all low(40.0%,59.3%,62.3%,respectively),susceptibility rates of C.tropicalis and C.krusei to itraconazole were also low(62.3%,60.0%,respectively).Multivariate analysis showed that organ failure(OR=5.872,P<0.001)and septic shock(OR=3.313,P=0.005)were independent risk factors for the death of patients with HAC.Conclusion C.albicans is the most common pathogens causing candidemia,Candida spp.is detected to be resistant to fluconazole,flucytosine and itraconazole,patients with candidemia have multiple underlying diseases,serious illness and high mortality,organ failure and septic shock are independent risk factors for the death of patients with candidemia.