老年假丝酵母血流感染流行病学及预后危险因素

Epidemiological characteristics of elderly patients with Candida bloodstream infection and risk factors for prognosis

目的探讨老年假丝酵母血流感染患者流行病学及预后危险因素。方法回顾性选取天津市第三中心医院2014年1月-2023年12月确诊为假丝酵母血流感染的103例老年患者为研究对象,根据患者预后分为存活组61例和死亡组42例,分析患者科室分布、分离菌种分布及耐药性,多因素Logistic回归分析预后危险因素。结果103例老年假丝酵母血流感染患者中,白假丝酵母感染者占54.37%(56/103),非白假丝酵母感染者占45.63%(47/103),主要分布在重症监护室(ICU)和肝胆外科,分别占45.63%(47/103)和17.48%(18/103);白假丝酵母对氟康唑的敏感率为75.00%(42/56),对伏立康唑的敏感率为76.79%(43/56);多因素Logistic回归分析显示,糖尿病(OR=3.499,95%CI:1.261~9.705,P=0.016)和感染性休克(OR=7.107,95%CI:1.225~41.226,P=0.029)是老年假丝酵母血流感染患者死亡的危险因素。结论白假丝酵母是老年假丝酵母血流感染的最主要菌种,糖尿病和感染性休克是其死亡的危险因素,对老年高危患者进行及时、充分的抗真菌治疗对患者预后有重要意义。

OBJECTIVE To explore the epidemiological characteristics of the elderly patients with Candida bloodstream infection and analyze the risk factors for prognosis.METHODS A total of 103 elderly patients who were diagnosed with Candida bloodstream infection and were treated in the Third Central Hospital of Tianjin from Jan 2014 to Dec 2023 were recruited as the research subjects and were divided into the survival group with 61 cases and the death group with 42 cases according to the prognosis of the patients.The distribution of the patients in departments,distribution of isolated species of pathogens and drug resistance were observed.Multivariate logistic regression analysis was performed for the risk factors for the prognosis.RESULTS Among the 103 elderly patients with Candida bloodstream infection,the patients with C.albicans infection accounted for 54.37%(56/103),and the patients with non-Candida albicans infection accounted for 45.63%(47/103);the patients from intensive care unit(ICU)accounted for 45.63%(47/103),and the patients from hepatobiliary surgery department accounted for 17.48%(18/103).The drug susceptibility rate of the C.albicans to fluconazole was 75.00%(42/56),and the drug susceptibility rate to voriconazole was 76.79%(43/56).The result of multivariate logistic regression analysis showed that diabetes mellitus(OR=3.499,95%CI:1.261-9.705,P=0.016)and septic shock(OR=7.107,95%CI:1.225-41.226,P=0.029)were the risk factors for death of the elderly patients with Candida bloodstream infection.CONCLUSION C.albicans is the predominant species of pathogen isolated from the elderly patients with Candida bloodstream infection.Diabetes mellitus and septic shock are the risk factors for the death of the patients.It is of great significance for the prognosis of the patients to carry out timely and fully antifungal therapy for the high-risk elderly patients.