无菌部位侵袭性真菌感染的病原学特点及预后不良危险因素分析

Etiological characteristics and risk factors of invasive fungal infections in sterile areas

目的探讨患者无菌部位侵袭性真菌感染(IFI)的菌种分布、药物敏感性、临床特征及预后不良危险因素。方法收集2019年7月至2023年6月于承德医学院附属医院从血液、胸腔、腹腔等无菌部位培养物分离出的真菌菌株,通过基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)等方法进行鉴定。酵母菌采用ATB Fungus 3酵母样真菌药敏试剂盒检测抗真菌药物敏感性。利用东华医院信息管理系统收集患者的临床和实验室资料,并进行统计分析。结果175株真菌菌株主要由酵母菌(169/175,96.57%)和丝状真菌(6/175,3.43%)构成,白念珠菌是IFI最常见致病菌(91/175,52.00%)。单因素分析显示,入住ICU、中心静脉置管、机械通气、连续性肾脏替代治疗(CRRT)、感染性休克及感染热带念珠菌是患者预后的影响因素(P<0.05)。多因素Logistic回归分析发现机械通气与感染热带念珠菌是患者预后不良的独立危险因素。降钙素原(PCT)是IFI患者预后不良的可靠预测指标。药敏结果显示多数光滑念珠菌和热带念珠菌的耐药株出现唑类交叉耐药的现象。结论临床需重视非白念珠菌,尤其是重视光滑念珠菌和热带念珠菌对唑类药物的耐药率及交叉耐药。

Objective To investigate the strain distribution,drug sensitivity,clinical characteristics,and risk factors of invasive fungal infection(IFI)in sterile sites of patients.Methods Fungal strains isolated from cultures of sterile sites,such as blood,chest cavity and abdominal cavity,were collected from the Affiliated Hospital of Chengde Medical College from July 2019 to June 2023,and identified by the matrix-assisted laser desorption/ionization time of flight mass spectrometry(MALDI-TOF MS)and other methods.The antifungal drug sensitivity of yeast was detected using the ATB Fungus 3 yeast-like fungal drug sensitivity kit.The clinical and laboratory data of patients were collected and analyzed using Donghua Hospital Information Management System.Results A total of 175 fungal strains mainly consisted of yeast(169/175,96.57%)and filamentous fungi(6/175,3.43%).Candida albicans was the most common pathogen causing invasive fungal infection(91/175,52.00%).Univariate analysis showed that ICU admission,central venous catheterization,mechanical ventilation,continuous renal replacement therapy(CRRT),septic shock and Candida tropicalis infection were the factors affecting patient prognosis(P<0.05).Multivariate logistic regression analysis found that mechanical ventilation and Candida tropicalis infection were the independent risk factors for the poor prognosis of patients.Procalcitonin(PCT)was a reliable predictor of poor prognosis in IFI patients.The drug sensitivity results showed that most resistant strains of Candida glabrata and Candida tropical exhibited cross-resistance to azole drugs.Conclusion Clinical attention should be paid to the resistance rate and cross-resistance of non-Candida albicans,especially Candida glabrata and Candida tropicalis to azole drugs.