CAJ | 학술논문

目的研究综合医院侵袭性念珠菌院内感染的流行病学特点.方法采用回顾性研究方法,连续收集2004年1月至2006年9月北京朝阳医院(CYH)和北京协和医院(PUMCH)诊断的侵袭性念珠菌院内感染资料,研究发生率和病死率,确定抗真菌治疗和预后的关系;采用微量肉汤稀释法判定念珠菌对常见抗真菌药物的体外敏感性.结果 2家医院侵袭性念珠菌院内发生率逐年上升,CYH和PUMCH分别由2004年的0.053%和0.025%升高到2006年的0.074%和0.049%.菌血症是侵袭性念珠菌感染的主要类型(55.8%),其次是腹腔感染(26.O%)、胸腔感染(9.1%)和胆道感染(7.8%).白念珠菌占院内侵袭性念珠菌感染的首位(57.1%),热带念珠菌第2位(19.5%),其次是光滑念珠菌(14.3%)和近平滑念珠菌(2.6%).氟康唑对于白念珠菌、热带念珠菌、光滑念珠菌和近平滑念珠菌的敏感性分别为97.7%、86.7%、63.6%和100%;两性霉素B对不同念珠菌属的敏感性均为100%.侵袭性念珠菌感染粗病死率37.7%;其中43例念珠菌血症未接受抗真菌治疗者病死率为72.7%,接受抗真菌治疗者病死率37.5%,两组差异有统计学意义(P=0.043).氟康唑的治愈率在PUMCH为63.6%,在CYH为52.6%.结论侵袭性念珠菌院内感染在大型综合医院发生率逐渐上升,病死率高,应该不断加强侵袭性念珠菌感染的监测,努力提高合理应用抗真菌药物的水平.
목적 연구종합의원침습성념주균원내감염적류행병학특점.방법 채용회고성연구방법,련속수집2004년1월지2006년9월북경조양의원(CYH)화북경협화의원(PUMCH)진단적침습성념주균원내감염자료,연구발생솔화병사솔,학정항진균치료화예후적관계;채용미량육탕희석법판정념주균대상견항진균약물적체외민감성.결과 2가의원침습성념주균원내발생솔축년상승,CYH화PUMCH분별유2004년적0.053%화0.025%승고도2006년적0.074%화0.049%.균혈증시침습성념주균감염적주요류형(55.8%),기차시복강감염(26.O%)、흉강감염(9.1%)화담도감염(7.8%).백념주균점원내침습성념주균감염적수위(57.1%),열대념주균제2위(19.5%),기차시광활념주균(14.3%)화근평활념주균(2.6%).불강서대우백념주균、열대념주균、광활념주균화근평활념주균적민감성분별위97.7%、86.7%、63.6%화100%;량성매소B대불동념주균속적민감성균위100%.침습성념주균감염조병사솔37.7%;기중43례념주균혈증미접수항진균치료자병사솔위72.7%,접수항진균치료자병사솔37.5%,량조차이유통계학의의(P=0.043).불강서적치유솔재PUMCH위63.6%,재CYH위52.6%.결론 침습성념주균원내감염재대형종합의원발생솔축점상승,병사솔고,응해불단가강침습성념주균감염적감측,노력제고합리응용항진균약물적수평.
Objective To investigate the epidemiologieal characteristics of invasive n080cornjal eandidiasis in teaching hospitals in Beijing.Methotis The clinical data of consecutive cases diagnosed as with nosecomial candidiasis hospitalized in Beijing Chaoyang Hospital(CYH)(n=43)and Peking Union Medical College Hospital(PUMCH)(n=34)from January 2004 to September 2006 were retrospectively analyzed to evaluate the incidence and mortality,and the relationship between antifungal therapy and outcomes.The minimum inhibitory concentrations(MICs)for Gandida spp were determined by microdilution method.Results The incidence rates of nosocomial candidiasis of CYH and PUMCH were 0.053% and 0.025%respectively in 2004.and increased to 0.cr74%and 0.049%respectively in 2006.Candidemia accounted for 55.8%(43/77)of the Candida infection,followed by intra-abdominal infection(26.0%,n=20),intra-thoracic infection(9.1%,n=7),and biliary tract infection(7.8%,n=6).The species mostly frequently isolated were Candida albicans(57.1%),followed by C. tropicalis(19.5%),C.glabrata(14.3%),and C. parasilosis(2.6%).The susceptibility rotes of C. albicans,C. tropicalis,C.glabrata.and C. parusilosis to fluconazole were 97.7%.86.7%,63.6%.and 100%respectively.No isolates were resistant to amphotericin B.The crude mortality rate of Candida infection was 37.7%.The mortality rate of the candidemia patients who did not receive systemic antifurlgal therapy was 72.7%,significantly higher than those who received antifungal therapy(37.5%,P=0.043).Most patients received fluconazole as the first choice(91.7%in PUMCH and 79.2%in CYH)with the survival rotes of 63.6% and 52.6%reslmctively.Conclusion With high morbidity and mortality,invasive nosocomial candidiasis is a big problem in teaching hospitals.Further investigation is necessary to evaluate the incidence and to idantify which antifungal agents are most protective for candidiasis.