血液肿瘤患者念珠菌血症的药物治疗及临床特点

Clinical characteristics and drug treatment of candidemia in patients with hematological tumor

目的分析血液肿瘤患者念珠菌血症特点,为临床治疗提供依据。方法回顾性分析2014年8月至2019年12月在北京大学第三医院血液科收治的血液肿瘤且住院期间发生念珠菌败血症的10例患者的临床特征、血培养结果、药敏结果、实验室检查、临床治疗及预后。结果 10例患者中男性5例,女性5例,中位年龄55.5岁;发生念珠菌血症前原发病状态8例为难治复发、1例为初治、1例为缓解;8例血培养结果为热带念珠菌,1例为白念珠菌,1例为克柔念珠菌。药敏结果显示:10株菌株均对5-氟胞嘧啶及两性霉素敏感,氟康唑和伊曲康唑各有2株耐药菌株,伏立康唑有1株耐药菌株。10例患者均存在中性粒细胞缺乏,8例患者1-3-β-D-葡聚糖试验阳性,3例患者半乳甘露聚糖试验阳性,7例患者降钙素原高于0.5 ng·mL^(-1),7例患者血清白蛋白低于30 g·L^(-1)。10例患者中5例死亡,其中粒细胞缺乏至首次血培养阳性的时间大于14 d、血清白蛋白<30 g·L^(-1)、原发疾病是否缓解与患者的生存相关(均P<0.05)。结论血液肿瘤患者念珠菌血症死亡率高,对高危人群应以预防性及经验性抗真菌治疗为主,并警惕耐药菌株的出现。

Objective To analyze the characteristics of candidemia in patients with hematologic tumor and to provide basis for clinical treatment. Methods The clinical characteristics, blood culture results, drug sensitivity results, laboratory examination, clinical treatment and prognosis of 10 patients with candidal septicemia from August 2014 to December 2019 were analyzed retrospectively. Results Among the 10 patients, 5 were male and 5 were female. The median age was 55.5 years. For their primary diseases, 8 cases were refractory relapse, 1 case was primary treatment and 1 case was remission. The blood culture results of 8 cases were Candida tropicalis, 1 case was Candida albicans and 1 case was Candida crenulatus. The drug sensitivity results showed that 10 strains were sensitive to 5-fluorocytosine and amphotericin. Fluconazole and itraconazole had 2 drug-resistant strains respectively, voriconazole had 1 drug-resistant strain. Neutropenia was found in 10 patients, 1-3-β-D-glucan test was positive in 8 patients, galactomannan test was positive in 3 patients, procalcitonin in 7 patients was higher than 0.5 ng·mL^(-1), serum albumin in 7 patients was lower than 30 g·L^(-1);5 of 10 patients died, of which agranulocytosis was up to the first blood culture The positive time was more than 14 days,the serum albumin was less than 30 g·L^(-1),the remission of primary disease was related to the survival of patients( all P < 0. 05). Conclusion The mortality rate of candidemia in patients with blood tumor is high. Preventive and empirical antifungal therapy should be the main treatment for high-risk population,and the emergence of resistant strains should be on guard.