真菌血流感染患者死亡率相关危险因素分析

Analysis of the risk factors for mortality in patients with fungal bloodstream infection

目的研究南京医科大学第一附属医院真菌血流感染的病原菌分布及与死亡率相关的危险因素,为临床真菌血流感染提供病原学依据及防治措施。方法收集2016年1月-2018年12月107例真菌血流感染患者临床资料,并按患者结局分为生存组、死亡组,用χ^2检验进行单因素分析,将单因素分析中显示与死亡率相关(P<0.05)的所有变量,采用logistic二元回归进行多因素分析。结果2016—2018年血培养共分离到真菌117株,主要分布于ICU和血液科,占53.0%;排在前三位的菌种分别是光滑念珠菌(28.2%,33/117)、白念珠菌(20.5%,24/117)和近平滑念珠菌(17.9%,21/117)。107例真菌血流感染患者中死亡17例,死亡率15.9%(17/107);单因素分析显示ICU入住、机械通气、抗真菌治疗和初始(1,3)-β-D-葡聚糖>100 ng/L与死亡率相关(P<0.05),logistic二元回归分析结果提示初始(1,3)-β-D-葡聚糖>100 ng/L(OR=6.364,95%CI:1.076~37.623,P=0.041)是与真菌血流感染患者死亡率相关的独立危险因素。结论初始(1,3)-β-D-葡聚糖>100 ng/L是与真菌血流感染患者死亡率相关的独立危险因素,临床应进行血培养和(1,3)-β-D-葡聚糖联合检测,对于阳性结果尽早干预以降低死亡风险。

Objective To study the distribution of pathogens and risk factors for death in fungal bloodstream infections in the First Affiliated Hospital of Nanjing Medical University,and to provide etiological evidence for managing fungal bloodstream infections.Methods The clinical data were reviewed for 107 patients with fungal bloodstream infections treated in the hospital from January 2016 to December 2018.The patients were assigned to survival group or death group according to the outcome.Univariate analysis was carried out to identify the potential predictors of mortality by means of Chi-square test.Then a multivariate logistic model was fitted to the data,considering all variables that had shown an association(P<0.05)with mortality in the univariate analysis.Results From 2016 to 2018,117 fungal strains were isolated from blood culture,mostly(53.0%)in intensive care unit and hematology department.The top three fungal species were Candida glabrata(28.2%,33/117),Candida albicans(20.5%,24/117),and Candida parapsilosis(17.9%,21/117).The overall mortality rate was 15.9%(17/107).Univariate analysis showed that ICU admission,mechanical ventilation,antifungal therapy,and initial(1,3)-β-D-glucan>100 ng/L were associated with mortality(P<0.05).Final multivariate model indicated that initial(1,3)-β-D-glucan>100 ng/L(odds ratio,6.364;95%CI:1.076-37.623,P=0.041)was a risk factor for mortality in patients with fungal bloodstream infection.Conclusions The initial(1,3)-β-D-glucan level>100 ng/L is a risk factor for predicting mortality in patients with fungal bloodstream infection.Blood culture should be combined with(1,3)-β-D-glucan tests in clinical practice.Positive result of(1,3)-β-D-glucan should be intervened as soon as possible to reduce the risk of death.