腹部大手术后希木龙念珠菌血症13例临床分析

Clinical analysis of 13 cases of Candida haemulonii after major abdominal surgery

目的探讨腹部大手术后希木龙念珠菌血症的临床表现、感染特点、危险因素、治疗效果及转归等情况。方法收集2018年3月—2021年8月平顶山市第一人民医院普外三科腹部大手术后13例希木龙念珠菌血症患者的临床特点、血培养结果、药敏结果、治疗转归等资料进行回顾性分析。结果13例患者平均年龄66岁,男6例、女7例,11例(84.6%)患恶性肿瘤,平均手术时间187 min,平均住院时间28.9 d。所有患者均有经外周静脉穿刺中心静脉置管(PICC)、肠外营养及腹腔引流管。13例希木龙念珠菌血症患者术后感染前均使用抗生素,其中11例使用3种抗生素,2例使用4种抗生素,使用时间5~17 d,平均8.5 d。12例患者出现低热,11例纳差、乏力,5例腹胀、呕吐。7例患者真菌G试验结果明显升高。希木龙念珠菌体外对5-氟胞嘧啶、氟康唑、伏立康唑、两性霉素B耐药率高达76.9%,对卡泊芬净、米卡芬净的敏感率较高,分别为92.3%、100%。结论腹部大手术后希木龙念珠菌血症临床表现、辅助检查无特异性,发生的危险因素可能为腹腔引流管的置入、手术时间长、PICC的置入、肠外营养、低蛋白血症、恶性肿瘤、抗菌药物使用等,对高危患者应关注希木龙念珠菌感染的可能。

Objective To investigate the clinical manifestations,microbiological features,risk factors,treatment effect and outcome of Candida haemulonii infection after major abdominal surgery.Methods We retrospectively reviewed the clinical characteristics,blood culture results,antimicrobial susceptibility testing results,treatment,and outcome of 13 patients infected with C.haemulonii after major abdominal surgery in the Department of General Surgery of Pingdingshan First People's Hospital during the period from March 2018 to August 2021.Results The 13 patients included 6 males and 7 females,average age of 66 years old.Most(84.6%)of the patients had malignant tumors.The average operation time was 187 min.The average hospital stay was 28.9 days.All patients had peripherally inserted central catheter(PICC),parenteral nutrition,and abdominal drainage tube.All the 13 patients with C.haemulonii sepsis received antibiotics before postoperative infection,including 3 antibiotics in 11 cases and 4 antibiotics in 2 cases.The treatment duration was 5-17 days,average of 8.5 days.Twelve patients had low fever.Eleven patients had anorexia and fatigue.Five patients had abdominal distension and vomiting.The value of fungal G test increased significantly in 7 patients.Overall,76.9% of the C.haemulonii isolates were resistant to 5-fluorocytosine,fluconazole,voriconazole,and amphotericin B.However,92.3% and 100% of the C.haemulonii isolates were susceptible to caspofungin and micafungin,respectively.Conclusions The clinical manifestations and auxiliary test results of C.haemulonii infection after major abdominal surgery were not specific.Placement of abdominal drainage tube,long operation time,PICC insertion,parenteral nutrition,hypoproteinemia,malignant tumor,and prior antibiotic use are the risk factors for C.haemulonii infection after major abdominal surgery.Attention should be paid to the possibility of C.haemulonii infection in high risk patients.