热带念珠菌所致血流感染的临床及实验室分析

Clinical and laboratory analysis of bloodstream infection caused by Candida tropicalis

目的通过对热带念珠菌所致血流感染的临床特征及实验室检查结果进行分析,为临床预防及诊治提供一定的参考依据。方法收集2018年1月至2020年12月四川大学华西医院热带念珠菌血流感染患者的临床资料,回顾性统计分析患者的临床特征及实验室检查结果等。结果27例热带念珠菌血流感染患者均有基础疾病且伴有2种及以上危险因素,(1,3)-β-D-葡聚糖试验对辅助诊断热带念珠菌血流感染有很好的灵敏度,其余炎性指标如超敏C反应蛋白、降钙素原、白细胞介素-6均有不同程度增高;27株热带念珠菌对唑类抗真菌药物的敏感率依次为伊曲康唑(77.8%)、伏立康唑(48.2%)、氟康唑(48.2%)、泊沙康唑(37.0%),对两性霉素B、卡泊芬净、米卡芬净敏感率均是100%。结论热带念珠菌血流感染常发生于有基础疾病且合并多种危险因素的患者,针对临床高危患者,应及时完善实验室检查以明确诊断;热带念珠菌对唑类药物的敏感性较差,临床治疗时应重视药敏结果、合理用药、及时控制患者症状。

Objective To analyze the clinical characteristics and laboratory results of bloodstream infection caused by Candida tropicalis in order to provide reference for clinical and prevention.Methods The clinical data of patients with bloodstream infection caused by Candida tropicalis in West China Hospital Sichuan University from January 2018 to December 2020 were collected,and the related clinical characteristics and laboratory examination of the patients were analyzed retrospectively.Results The 27 patients with bloodstream infection caused by Candida tropicalis had basic diseases and two or more risk factors.(1,3)-β-D-glucan test had a good sensitivity in the auxiliary diagnosis of Candida tropicalis bloodstream infection.Other inflammatory indexes such as high sensitive C-reactive protein,procalcitonin and interleukin-6 were increased in varying degrees.The sensitivity rates of 27 strains of Candida tropicalis to azole antifungal drugs were itraconazole(77.8%),voriconazole(48.2%),fluconazole(48.2%),posaconazole(37.0%).The sensitivity rate to amphotericin B,caspofungin and micafungin was 100%.Conclusion Candida tropicalis bloodstream infection often occured in patient with underlying diseases and a variety of risk factors Candida tropicalis had poor sensitivity to azole drugs,so we should pay attention to drug sensitivity results in clinical treatment.