老年念珠菌血流感染患者临床特征及预后影响因素分析

Analysis of clinical characteristics and prognostic factors influencing the prognosis of elderly patients with Candida bloodstream infection

目的分析30 d不同预后老年念珠菌血流感染患者的临床特征及预后影响因素。方法收集2018年1月—2023年12月广州某三级甲等医院收治的58例≥65岁老年念珠菌血流感染患者资料,根据30 d预后情况分成存活组(34例)与死亡组(24例)分析其临床特点以及影响预后的因素。结果老年念珠菌血流感染患者死亡率41.4%(24/58例),两组感染菌株均以白念珠菌、光滑念珠菌、近平滑念珠菌、热带念珠菌为主,分离菌株对体外药敏试验耐药率低,两组的不同菌株占比、药物敏感性、感染部位差异无统计学意义。对两组预后单因素分析显示白细胞计数、C反应蛋白、降钙素原等炎症指标增高,血清蛋白降低,有呼吸系统基础疾病是患者死亡的危险因素(P<0.05);多因素回归分析提示血清蛋白降低是患者死亡的独立危险因素(OR=0.800,95%CI 0.676~0.946)。血培养报阳后48 h内未使用抗真菌治疗患者死亡率显著增高。结论老年患者因呼吸系统等基础疾病是念珠菌血流感染的高危人群,一旦感染预后差、死亡率高,及时纠正低蛋白血症,及时进行抗真菌治疗,对提高患者的预后有积极意义。

Objective Analysis of clinical characteristics and prognostic factors influencing the prognosis of elderly patients with Candida bloodstream infections with different prognoses at 30 days.Methods Data were collected from 58 cases of Candida bloodstream infections in elderly patients over 65 years old in a tertiary hospital in Guangzhou from January 2018 to December 2023.These caseswere divided into a survival group(34 cases)and a death group(24 cases)according to 30-day prognosis to analyze their clinical characteristics and factors affecting prognosis.Results Elderly patients with Candida bloodstream infection had a mortality rate of 41.4%(24/58 cases),and the infecting strains in both groups were predominantly Candida albicans,C.glabrata,C.parapsilosis and Candida tropicalis,and the isolates had a low resistance rate in vitro,and there was no significant difference in the percentage of different strains,drug sensitivity,and distribution of infected parts between the two groups.Univariate analysis of the prognosis of the two groups showed that increased inflammatory indexes such as leukocyte count,C-reactive protein,and calcitoninogen,decreased serum proteins,and the presence of underlying respiratory diseases were risk factors for patient death(P<0.05);multifactorial regression analysis suggested that decreased serum proteins were was an independent risk factor for patient death(OR=0.800,95%CI 0.676~0.946).Significantly higher mortality in patients not treated with antifungal therapy within 48 h of positive blood culture was reported.Conclusion Elderly patients are at high risk for Candida bloodstream infections due to underlying respiratory diseases.Once infected,the prognosis is poor and the mortality rate is high.Timely correction of hypoproteinemia and timely antifungal treatment have positive significance in improving the prognosis.