2013—2022年某医院真菌血流感染患者临床特点及死亡危险因素分析

Clinical characteristics and risk factors for mortality of patients with fungal bloodstream infection in a hospital from 2013 to 2022

目的探讨真菌血流感染患者病原菌分布及其预后,并对其相关危险因素进行分析,为临床诊治真菌血流感染患者提供经验和依据。方法选取2013年12月—2022年12月江苏省苏北人民医院真菌血流感染患者为研究对象,回顾性分析这些患者的真菌分布类型﹑药物敏感性﹑相关危险因素及其预后。结果195例真菌血流感染病例中,男性133例,平均年龄66岁;女性62例,平均年龄65岁;以白念珠菌、热带念珠菌、光滑念珠菌为主,分别占45.4%、16.9%、15.3%;死亡101例,死亡率为51.8%;死亡患者中检出最高的为白念珠菌(50.5%,51/101);单因素分析显示住院时长、肾功能不全、肝功能不全、基础疾病≥2种、ICU入住、机械通气、气管插管、留置导管、碳青烯类药物使用与死亡率有关(P<0.05),多因素logistic二元回归分析结果提示住院时长、基础疾病≥2种和气管插管是与真菌血流感染患者死亡率相关的独立危险因素。结论患者的住院时长、基础疾病≥2种和气管插管可能作为真菌血流感染死亡独立危险因素存在,本研究真菌血流感染中最常见的是白念珠菌感染,热带念珠菌和光滑念珠菌对唑类药物的敏感性较低。

Objective To investigate the pathogenic distribution and prognosis of patients with fungal bloodstream infection,and analyze the related risk factors,so as to provide experience and basis for clinical diagnosis and treatment of fungal bloodstream infection.Method Patients with fungal bloodstream infection in Subei People's Hospital of Jiangsu Province from December 2013 to December 2022 were selected as the study objects,and the fungal distribution,antifungal sensitivity,related risk factors and prognosis of these cases were retrospectively analyzed.Results Among 195 cases of fungal bloodstream infection,133 were male,with an average age of 66 years.There were 62 female patients with an average age of 65 years.Candida albicans,Candida tropicalis and Candida glabrata accounted for 45.4%,16.9%and 15.3%of the 195 cases of fungal bloodstream infection,respectively.101 cases died,the mortality rate was 51.8%;The detection of Candida albicans in death patients was the highest(50.5%,51/101);univariate analysis showed that length of hospital stay,renal insufficiency,liver insufficiency≥2 underlying diseases,ICU admission,mechanical ventilation,tracheal intubation,indent catheter,and carbapenyl drug use were associated with mortality(P<0.05).The results of multivariate logistic binary regression analysis indicated that length of stay,≥2 underlying diseases and tracheal intubation were independent risk factors associated with mortality in patients with fungal bloodstream infection.Conclusion Hospital length of stay,≥2 kinds of underlying diseases and tracheal intubation were independent risk factors for mortality in fungal bloodstream infections.Candida albicans was the most seen isolate in fungal bloodstream infection,while Candida tropicalis and Candida glabrata showed lower sensitivity to azole antifungal agents.