念珠菌血流感染临床特征及死亡相关危险因素分析

Analysis of clinical features and death-related risk factors of Candida bloodstream infection

目的探讨念珠菌血流感染的临床特点。方法收集本院2017年1月—2021年12月确诊为念珠菌血流感染62例患者的临床资料,统计分析感染菌种分布、临床特征及死亡危险因素。结果62例念珠菌血流感染患者共分离到65株真菌,主要分布在重症病房(33株)、泌尿外科(7株)和血液内科(6株)等科室;菌种以白念珠菌(29.2%)、光滑念珠菌(26.2%)、近平滑念珠菌(21.5%)、热带念珠菌(18.5%)为主,总体对氟康唑非敏感率38.5%。62例念珠菌血流感染患者中34例死亡,死亡率54.8%;单因素分析显示入住重症病房、机械通气、合并肺部感染、重度低蛋白血症和血培养报阳后48 h内未启动抗真菌治疗与死亡率相关(P<0.05);logistic回归分析提示重度低蛋白血症(OR=7.924,95%CI 1.851~34.599,P=0.006)、初次血培养报阳后48 h内未启动抗真菌治疗(OR=6.828,95%CI 1.377~33.852,P=0.019)是患者死亡独立危险因素。结论念珠菌血流感染患者具有合并症多、死亡率高特点,感染以非白念珠菌为主,重度低蛋白血症是念珠菌血流感染患者死亡独立危险因素,尽早抗真菌治疗对患者预后有重要意义。

Objective To explore the clinical features of Candida bloodstream infection.Methods The clinical data of 62 patients diagnosed with Candida bloodstream infection in our hospital from January 2017 to December 2021 were collected,and the distribution of pathogen,clinical characteristics and risk factors of death were analyzed.Results A total of 65 strains of fungi were isolated from 62 patients with Candida bloodstream infection,mainly distributed in the intensive care unit(33 strains),urology(7 strains)and hematology(6 strains)departments;the strains were Candida albicans(29.2%),Candida glabrata(26.2%),Candida parapsilosis(21.5%),and Candida tropicalis(18.5%),and the overall non-susceptibility rate to fluconazole was 38.5%.Among 62 patients with Candida bloodstream infection 34 died,and the mortality rate was 54.8%;Univariate analysis showed that admission to intensive care unit,mechanical ventilation,combined lung infection,severe hypoalbuminemia,and no antifungal therapy within 48 hours after positive blood culture were associated with mortality(P<0.05).Logistic regression analysis showed that severe hypoalbuminemia(OR=7.924,95%CI 1.851~34.599,P=0.006)and failure to initiate antifungal therapy within 48 hours after the initial blood culture report(OR=6.828,95%CI 1.377~33.852,P=0.019)were independent risk factors for death.Non-albicans Candida infection was the main,and severe hypoalbuminemia was an independent risk factor for death in patients with Candida bloodstream infection.Early antifungal therapy was important for patient prognosis.Conclusion Candida bloodstream infection patients were characterized by multiple comorbidities and high mortality.