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院内念珠菌血症临床特点及病原菌分析 被引量:3

Clinical characteristics and pathogen of patients with candidemia
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摘要 目的探讨念珠菌血症患者的临床特点、病原种类、药敏试验及治疗预后。方法回顾性分析山东淄博市中心医院2011年1月至2018年12月期间住院念珠菌血症患者的临床资料,描述其危险因素、临床特点、念珠菌种类分布、药敏情况及治疗转归。结果住院念珠菌血症患者主要来源于ICU(35.9%),多为老年患者(>60岁,75.7%)。白念珠菌是最常见的分离菌株(40.8%),其次是热带念珠菌(20.4%)、近平滑念珠菌(20.4%)、光滑念珠菌(10.7%)和克柔念珠菌(3.9%)。2011年到2018年间,白念珠菌的分离率呈现先增高后降低的趋势,近年非白念菌株检出比例上升。念珠菌对唑类药物的耐药主要表现在热带念珠菌和光滑念珠菌,白念珠菌和近平滑念珠菌对唑类的敏感性亦呈现下降趋势。念珠菌血症患者30 d粗死亡率为39.8%,多因素回归分析显示高龄(OR=1.091,P=0.001)和糖尿病(OR=9.709,P=0.005)是独立危险因素,针对性抗真菌治疗(OR=0.142,P=0.008)可改善患者预后。结论对住院高危患者采取积极治疗基础疾病、减少侵入性操作等措施可减少念珠菌血症的发生,及时针对性应用抗真菌药物可改善患者预后。 Objective To explore clinical features,pathogen distribution,antifungal resistance and prognosis of patients with candidiamia.Methods The clinical data of inpatients with candidemia from January 2011 to December 2018 in Zibo Central Hospital were retrospectively studied,and the risk factors,clinical features,species distribution,drug sensitivity and clinical outcomes were described and analyzed.Results The inpatients with candidemia were mainly from ICU(35.9%),and most of them were elderly patients(>60 years old,75.7%).Candida albicans(40.8%)were the primary species,followed by C.tropicalis(20.4%),C.parapsilosis(20.4%),C.glabrata(10.7%)and C.krusei(3.9%).The separation rate of C.albicans showed the tendency of firstly increased and then decreased from 2011 to 2018,and non-albicans candidemia had risen in recent years.Azole resistance mainly arised in C.tropicalis and C.glabrata,and the sensitivity of C.albicans and C.parapsilosis to azole also declined.The 30-day crude mortality rate was 39.8%.Multivariate regression analysis revealed that agedness(OR=1.091,=0.001)and diabetes(OR=9.709,P=0.005)were independent risk factors,and targeted antifungal therapy(OR=0.142,P=0.008)could improve the prognosis of patients.Conclusion The incidence of candidemia can be reduced by treating basic diseases and reducing invasive operations in high-risk hospitalized patients,and the prognosis of patients can be improved by timely and targeted application of antifungal drugs.
作者 张文 罗莹 国承杰 徐英春 肖盟 类承斌 赵燕 毕蕾 ZHANG Wen;LUO Ying;GUO Cheng-jie;XU Ying-chun;XIAO Meng;LEI Cheng-bin;ZHAO Yan;BI Lei(Department of Clinical Laboratory, Zibo Central Hospital, Zibo 255036, China;Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China)
出处 《中国真菌学杂志》 CSCD 2020年第3期154-160,共7页 Chinese Journal of Mycology
基金 十三五国家科技重大专项(2018ZX10712001)。
关键词 念珠菌血症 危险因素 药敏试验 预后 candidemia risk factors antifungal susceptibility test prognosis
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