成人急性白血病并热带假丝酵母菌性败血症临床特点

CLINICAL FEATURES OF ADULT ACUTE LEUKEMIA WITH CANDIDA TROPICALIS SEPSIS

目的探讨急性白血病病人医院内感染热带假丝酵母菌性败血症的临床特点及危险因素。方法回顾分析2016年1月—2019年1月我院收治、经血培养证实为急性白血病合并热带假丝酵母菌性败血症10例病人的临床资料。结果10例病人血培养证实为热带假丝酵母菌感染。10例病人均有高热,伴寒颤5例,合并细菌性败血症2例,3例病人痰液培养出多重耐药菌;肺部症状10例;皮肤软组织感染2例;1例病人虽拔除静脉导管但仍然死亡;棘白菌素抗真菌治疗总有效率为40%。死亡6例,1例死于感染性休克,4例死于重症肺炎、呼吸衰竭,1例死于心力衰竭;发生感染至死亡时间为1~18 d。结论急性白血病医院感染热带假丝酵母菌性败血症临床表现不典型,病死率较高,治疗首选棘白菌素类。

Objective To investigate the clinical features and risk factors for nosocomial infection with Candida tropicalis sepsis in patients with acute leukemia.Methods A retrospective analysis was performed on the clinical data of 10 cases of acute leukemia with C.tropicalis sepsis confirmed by blood culture admitted to our hospital from January 2016 to January 2019.Results All of the ten patients were confirmed infected with C.tropicalis according to blood culture results.All ten patients had high fever(100%),of whom five were with shaking chills(50%),two were with bacterial sepsis(20%),and three had multidrug-resistant organisms in their sputum culture(30%);ten patients had pulmonary symptoms;two patients had skin and soft tissue infections.One case died after extubation.The echinocandin antifungal therapy had an overall response rate of 40%(4/10).Six cases died,of which one died of septic shock,four died of severe pneumonia and respiratory failure,and one died of heart failure;the time from infection to death ranged from 1 to 18 d.Conclusion Nosocomial infection with C.tropicalis sepsis in cases of acute leukemia has atypical clinical manifestations and a high mortality rate.Echinocandins are preferred for the treatment.