泌尿系统念珠菌感染的病原菌分布及危险因素分析

目的分析本院就诊患者泌尿系统念珠菌感染的病原菌分布、耐药性,并初步探讨临床感染危险因素,为临床抗泌尿系统念珠菌感染的治疗提供依据。方法收集2021年5月至12月于本院就诊患者的中段尿培养念珠菌菌株,进行菌株鉴定及抗真菌药物敏感性试验,并查阅患者临床病历资料,初步探讨泌尿系统念珠菌感染的危险因素。结果共送检6,061份中段尿培养标本,念珠菌总体检出率为5.40%;病原菌分布以白念珠菌(41.26%)、热带念珠菌(35.44%)及光滑念珠菌(16.99%)为主,三者合计占比为93.69%;患者分布男性占比53.40%,女性占比46.60%;多数为老年患者,>60岁患者占比66.02%;科室分布以神经外科、泌尿外科和康复科为主,三者共占全部科室的47.58%;全部念珠菌对U组抗真菌药物的整体敏感率较高,均>75.00%,最低的为热带念珠菌对氟康唑的敏感率(50.68%);全部念珠菌感染患者中,含有复杂尿感因素、使用≥2种抗菌药物、侵入性操作及合并其他部位感染的比例分别为40.29%、30.58%、28.64%及23.79%;使用≥2种抗菌药物和合并其他部位感染这两种危险因素在不同泌尿系统念珠菌感染分组中比例不完全相同,在光滑念珠菌感染分组,这两种危险因素的比例均高于热带念珠菌感染分组。结论泌尿系统念珠菌感染病原菌分布以白念珠菌和热带念珠菌为主,感染患者大多高龄、多分布于神经外科,念珠菌总体敏感率较高,在念珠菌感染前应用多种抗菌药物,有侵入性操作,且有发生复杂性尿路感染的危险因素,临床应合理应用抗菌药物,积极去除复杂尿感因素,防止进展为念珠菌血症。

Objective To analyze the distribution and drug resistance of pathogens in patients with urinary system candida infection in Jinhua Municipal Central Hospital,and preliminarily explore the risk factors of clinical infection,so as to provide the basis for clinical treatment of urinary system Candida infection.Methods Candida strains were collected in midstream urine culture of patients who visited Jinhua Municipal Central Hospital from May to December,2021,the identification of strains and antifungal drug susceptibility tests were carried out.In the meantime,the clinical medical records of patients were consulted.Based on these data,the risk factors of urinary tract candida infection were preliminarily explored.Results A total of 6061 midstream urine culture specimens were sent for inspection,the overall detection rate of candida was 5.40%.The distribution of pathogenic candida was dominated by candida albicans(41.26%),candida tropicalis(35.44%)and candida glabrata(16.99%),these accounted for 93.69%.Male patients accounted for 53.40%,while females accounted for 46.60%.Most of them were elderly patients,patients over 60 years old accounted for 66.02%.The distribution of departments was mainly Neurosurgery,Urology and Rehabilitation,which accounted for 47.58%of all departments.The overall sensitivity rate of all candida species to antifungal drugs in group U was higher than 75.00%,and the lowest was the sensitivity rate of candida tropicalis to fluconazole(50.68%).Among all patients with candida infection,the proportions of complicated urinary tract factors,use of two or more antibiotics,invasive procedures and infections in other parts were 40.29%,30.58%,28.64%and 23.79%,respectively.The use of two or more antibiotics and other risk factors for infection at other sites were not all the same in different groups of urinary candidiasis.The proportions of both risk factors were higher in the Candida glabrata infection group than in the candida tropicalis infection group.Conclusion Candida albicans and candida tropicalis are the main pathogens in urinary system candida infection.Most of the infected patients are elderly and mostly distributed in Neurosurgery department.Candida susceptibility to commonly used antifungal drugs is generally high.Before the candida infection,patients are treated with multiple antibiotics,and has invasive procedures,risk factors for complicated urinary tract infections.Clinicians should rationally apply antibiotics,actively remove complicated urinary factors,and prevent progression to candidemia.