ICU获得性念珠菌血症流行病学及死亡相关因素分析

The epidemiology and predictors of mortality in patients with ICU-acquired candidaemia

目的总结ICU获得性念珠菌血症流行病学的改变,探讨ICU获得性念珠菌血症患者30 d死亡与早期(≤7 d)死亡的相关因素。方法选择2005年1月~2017年12月在广西医科大学第一附属医院ICU发生的获得性念珠菌血症患者为研究对象,收集患者的一般临床指标、念珠菌血症相关指标、预后指标及流行病学指标,总结ICU获得性念珠菌血症的流行病学改变。同时根据发病后30 d及7 d住院预后的不同分别将患者分为30 d死亡组与30 d存活组及早期(≤7 d)死亡组与早期(≤7 d)存活组,分别比较两组患者各指标的差异,并采用多因素Logistic回归分析ICU获得性念珠菌血症患者死亡的独立相关因素。结果本研究纳入ICU获得性念珠菌血症61例,总体发病率0.547%,发病率呈上升趋势[由0.373%(2005~2011年)上升至0.724%(2012~2017年)]。30 d住院病死率54.1%,呈下降趋势[由76.2%(2005~2011年)下降至42.5%(2012~2017年)]。早期死亡(≤7 d)住院病死率29.5%,亦呈下降趋势[由52.4%(2005~2011年)下降至17.5%(2012~2017年)]。多因素Logistic回归分析,氟康唑治疗是ICU获得性念珠菌血症30 d死亡的保护性因素(P=0.020)、APCHEⅡ评分≥20是ICU获得性念珠菌血症30天死亡的危险因素(P=0.039),氟康唑治疗(P=0.002)与棘白菌素治疗(P=0.011)是ICU获得性念珠菌血症早期(≤7 d)死亡的保护性因素。结论ICU获得性念珠菌血症发病率呈上升趋势,死亡率虽有下降趋势,但仍偏高。APCHEⅡ评分≥20是ICU获得性念珠菌血症30 d住院死亡的独立危险因素,氟康唑和棘白菌素治疗是ICU获得性念珠菌血症保护性因素。

Objective To summarize the epidemiological changes of ICU-acquired candidaemia(ICUAC)and explore the predictors of 30-day mortality and early(≤7 days)mortality.Methods The patients with ICUAC of the first affiliated hospital of Guangxi Medical University from January 2005 to December 2017 were selected.The general clinical data,indicators related to candidaemia,prognosis and epidemiological were collected,and the epidemiological changes and prognosis of ICUAC were summarized.The patients were divided into the death group and the survival group according to the different prognosis at 30 days or 7 days after the onset,and the differences of the indicators in the two groups were compared respectively.Multivariate Logistic regression was used to analyze the independent predictors of the death of patients with ICUAC.Results A total of 61 patients with ICUAC were collected,with an overall incidence of 0.547%cases and an increasing trend[from 0.373%cases(2005-2011)to 0.724%cases(2012-2017)].Thirty-three patients died within 30 days,with a 30-day mortality rate of 54.1%,showing a decreasing trend[from 76.2%(2005-2011)to 42.5%(2012-2017)].There were 18 patients of early death(≤7 days)with a mortality rate of 29.5%,which also showed a decreasing trend[from 52.4%(2005-2011)to 17.5%(2012-2017)].Fluconazole treatment is the protective factor of day-30 mortality in ICUAC patients(P=0.020),APACHE II score≥20 is independent predictors of day-30 mortality in ICUAC patients(P=0.039).Fluconazole treatment(P=0.002)and echinocandins treatment(P=0.011)are protective factors of early death(≤7days)in ICUAC patients.Conclusion The incidence of ICUAC is increasing,and the mortality rate is still high.Echinocandins treatment is protective factor of early(≤7days)mortality in ICUAC patients.Fluconazole treatment is the protective factor of day-30 and early(≤7days)mortality in ICUAC patients.APACHE II score≥20 is independent predictors of day-30 mortality in ICUAC patients.