重度烧伤患者真菌感染的病原学特征及危险因素

Etiological characteristics and risk factors of fungal infection in severe burn patients

目的分析重度烧伤患者真菌感染的病原学特征,探讨重度烧伤患者发生真菌感染的危险因素。方法选取广州市红十字会医院烧伤重症监护室(BICU)2013年1月-2022年12月符合纳入标准的598例重度烧伤患者作为研究对象,并统计其创面分泌物、痰液、血液、中段尿、粪便、导管尖端标本的真菌培养及药敏结果。根据《烧伤侵袭性真菌感染诊断与防治指南(2012版)》确诊侵袭性真菌感染(IFI)患者,分析感染患者与非感染患者的临床特征。结果10年间确诊为烧伤后IFI患者41例,真菌感染率6.86%,死亡5例,病死率12.16%。10年间41例烧伤后IFI患者共检出真菌124株,其中占比前三分别为热带念珠菌28株(22.58%)、近光滑念珠菌28株(22.58%)、白色念珠菌24株(19.35%);相较于前5年,后5年白色念珠菌占比下降,非白色念珠菌及罕见真菌占比提高。10年间烧伤后IFI患者阳性标本来源占比前三分别为创面分泌物(128份,53.56%)、血液(47份,19.67%)、痰液(28份,11.72%)。Ⅲ度烧伤面积(OR=1.03,95%CI:1.01~1.05)、机械通气≥14 d(OR=3.34,95%CI:1.10~12.62)、广谱抗生素种类≥3种(OR=4.97,95%CI:2.36~11.12)、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分(OR=1.18,95%CI:1.10~1.30)为烧伤患者真菌感染的独立危险因素(P均<0.05)。结论重度烧伤患者真菌感染呈上升趋势,非白色念珠菌及罕见真菌检出率增加。Ⅲ度烧伤面积,机械通气≥14 d,广谱抗生素种类≥3种,APACHEⅡ评分为烧伤患者真菌感染的独立危险因素。

Objective To analyze the etiological characteristics of fungal infections in patients with severe burns and to investigate the risk factors for fungal infections in these patients. Methods Selected 598 patients with severe burns who met the inclusion criteria from the Burn Intensive Care Unit(BICU) of the Red Cross Hospital in Guangzhou from January 2013 to December 2022 as research subjects. It also compiled the results of fungal cultures and drug sensitivity from wound secretions, sputum, blood, midstream urine, feces, and catheter tip specimens. Patients with invasive fungal infections(IFI) were diagnosed according to the “Guidelines for the Diagnosis and Prevention of Invasive Fungal Infections in Burns(2012 Edition)”,and the clinical characteristics of infected patients were compared with those of non-infected patients.Results Over the 10-year period, 41 patients were diagnosed with post-burn IFI, with a fungal infection rate of 6.86%, and 5 deaths, resulting in a mortality rate of 12.16%. A total of 124 fungal strains were isolated from 41 patients with post-burn IFI over the same period, with the top three comprising Candida tropicalis(28 strains, 22.58%), Candida parapsilosis(28strains, 22.58%), and Candida albicans(24 strains, 19.35%). Compared to the first 5 years, the proportion of Candida albicans decreased in the latter 5 years, while the proportion of non-albicans Candida and rare fungi increased. Over the 10years, the top three sources of positive samples for IFI patients were wound secretions(128 samples, 53.56%), blood(47samples, 19.67%), and sputum(28 samples, 11.72%). The independent risk factors for fungal infections in burn patients were the area of Ⅲ degree burns(OR=1.03, 95%CI:1.01-1.05,P<0.05), mechanical ventilation ≥14 days(OR=3.34, 95%CI: 1.10-12.62, P<0.05), use of ≥3 types of broad-spectrum antibiotics(OR=4.97, 95%CI: 2.36-11.12, P<0.05), and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score(OR=1.18, 95%CI: 1.10-1.30, P<0.05).Conclusions Fungal infections in patients with severe burns were on the rise, and the detection rate of non-albicans Candida and rare fungi had increased. The area of Ⅲ degree burns, mechanical ventilation ≥14 days, use of ≥3 types of broad-spectrum antibiotics, and the APACHE Ⅱ score were independent risk factors for fungal infections in burn patients.