血液病合并念珠菌血症病原学特征与预后影响因素分析

Pathogenic characteristics and prognostic risk factors of candidemia with hematological diseases

目的:探讨血液病合并念珠菌血症的病原学特征及预后,为临床诊治提供依据。方法:回顾性收集80例血液病合并念珠菌血症患者的临床资料,分析其病原学特征,并对患者确诊后30 d内死亡的危险因素进行分析。结果:80例血液病合并念珠菌血症病原学分析发现以热带念珠菌(68.8%)为主,其次为近平滑念珠菌、光滑念珠菌、白色念珠菌。药敏试验显示念珠菌对伏立康唑、氟康唑、伊曲康唑的耐药率分别是43.8%、46.3%、52.5%。Logistic回归分析结果显示原发病未缓解、感染性休克、多器官功能障碍综合征(MODS)是血液病合并念珠菌血症患者30 d内死亡的危险因素[OR(95%CI)为7.706(1.803~32.940)、10.211(1.071~97.379)和8.621(1.535~48.420)]。结论:血液病合并念珠菌血症死亡率高,以热带念珠菌感染为主,唑类药物耐药严重。原发病未缓解、感染性休克、MODS是患者死亡的危险因素。

Aim:To investigate the pathogenic characteristics and prognosis of candidemia with hematological diseases,and to provide evidence for its clinical diagnosis and treatment.Methods:Clinical characteristics of 80 hematological patients with candidemia were collected,and their pathogenic characteristics were analyzed.The risk factors of death within 30 days after diagnosis were analyzed.Results:Candidas were mainly Candida tropicalis(68.8%),followed by Candida parapsilosis,Candida glabrata,Candida albicans.The drug susceptibility test showed that the candida resistance rates to voriconazole,fluconazole and itraconazole were 43.8%,46.3%and 52.5%.Logistic regression analysis found that disease not in remission,septic shock,and multiple organ dysfunction syndrom(MODS)were risk factors for the mortality rate within 30 days in hematological patients with candidemia[OR(95%CI)were 7.706(1.803-32.940),10.211(1.071-97.379),and 8.621(1.535-48.420)].Conclusions:Candidemia in patients with hematological diseases is associated with high mortality rate,and the pathogenesis is dominated by Candida tropicalis infection with severe azole resistance.Disease not in remission,septic shock,and MODS are the risk factors for mortality.