CAJ | 학술논문

目的了解念珠菌血症患者的临床和微生物特征,探讨影响其预后的危险因素.方法回顾性分析2008年1月至2012年12月复旦大学附属中山医院血培养念珠菌阳性病例,对其病原菌种类、药敏结果、基础疾病、治疗及预后情况进行统计,并采用单因素及多因素回归分析方法对念珠菌血症死亡相关的危险因素进行分析.结果共收集138例念珠菌血症患者资料,其中男98例,女40例,平均年龄(61.3±16.6)岁；每年出院患者中的发病率为0.034％～0.051％.血培养分离到白念珠菌72株(52.2％),近平滑念珠菌29株(21.0％),热带念珠菌16株(11.6％).药敏结果显示,念珠菌对三唑类抗真菌药物的敏感率为90.9％～97.4％；而热带念珠菌对三唑类的敏感率仅为55.6％～83.3％.念珠菌血症患者的病死率为39.1％(54/138),归因病死率31.9％(44/138).多因素回归分析显示急性生理与慢性健康评分(APACHEⅡ)≥20分(OR=8.025,95％CI:2.032 ～31.696,P=0.003)、低白蛋白血症(OR=6.213,95％CI:1.849～ 20.879,P=0.003)及合并细菌血流感染(OR=5.541,95％ CI:1.576 ～ 19.487,P=0.008)、留置导尿管(OR=13.776,95％CI:1.402～135.352,P=0.024)是其死亡独立危险因素,而拔除或更换中心静脉置管(OR=0.231,59％ CI:0.075 ～0.716,P=0.011)及血培养前30 d内手术史(OR=0.206,95％CI:0.050～0.857,P=0.030)是其死亡的保护性因素.结论念珠菌血症以白念珠菌引起为主,病死率仍较高,APACHEⅡ评分≥20分、低蛋白血症、留置导尿管和合并细菌血流感染是死亡独立危险因素,拔除或更换中心静脉置管及血培养前30 d内手术史是预后保护性因素.
목적 료해념주균혈증환자적림상화미생물특정,탐토영향기예후적위험인소.방법 회고성분석2008년1월지2012년12월복단대학부속중산의원혈배양념주균양성병례,대기병원균충류、약민결과、기출질병、치료급예후정황진행통계,병채용단인소급다인소회귀분석방법대념주균혈증사망상관적위험인소진행분석.결과 공수집138례념주균혈증환자자료,기중남98례,녀40례,평균년령(61.3±16.6)세；매년출원환자중적발병솔위0.034％～0.051％.혈배양분리도백념주균72주(52.2％),근평활념주균29주(21.0％),열대념주균16주(11.6％).약민결과현시,념주균대삼서류항진균약물적민감솔위90.9％～97.4％；이열대념주균대삼서류적민감솔부위55.6％～83.3％.념주균혈증환자적병사솔위39.1％(54/138),귀인병사솔31.9％(44/138).다인소회귀분석현시급성생리여만성건강평분(APACHEⅡ)≥20분(OR=8.025,95％CI:2.032 ～31.696,P=0.003)、저백단백혈증(OR=6.213,95％CI:1.849～ 20.879,P=0.003)급합병세균혈류감염(OR=5.541,95％ CI:1.576 ～ 19.487,P=0.008)、류치도뇨관(OR=13.776,95％CI:1.402～135.352,P=0.024)시기사망독립위험인소,이발제혹경환중심정맥치관(OR=0.231,59％ CI:0.075 ～0.716,P=0.011)급혈배양전30 d내수술사(OR=0.206,95％CI:0.050～0.857,P=0.030)시기사망적보호성인소.결론 념주균혈증이백념주균인기위주,병사솔잉교고,APACHEⅡ평분≥20분、저단백혈증、류치도뇨관화합병세균혈류감염시사망독립위험인소,발제혹경환중심정맥치관급혈배양전30 d내수술사시예후보호성인소.
Objective To explore the microbiological and clinical characteristics of patients with candidemia and analyze their prognostic risk factors.Methods A retrospective analysis was conducted for hospitalized patients with candidemia from January 2008 to December 2012 at Affiliated Zhongshan Hospital,Fudan University.Pathogen spectrum,resistance pattern,underlying diseases,therapy received and patient prognosis were collected by chart review.The univariate and multivariate Logistic regression analyses were used to determine the prognostic risk factors of candidemia.Results A total of 138 inpatients were identified.There were 98 males and 40 females with a mean age of (61.3 ± 16.6) years.The morbidity rate of candidemia in annual discharged patients was 0.034％-0.051％.The most common pathogens were Candida albicans (n =72,52.2％),Candida parapsilosis (n =29,21.0％) and Candida tropicalis (n =16,11.6％).The antibiotic susceptible rate of azole for Candida was 90.9％-97.4％ while 55.6％-83.3％ for Candida tropicalis.The overall case fatality rate of candidemia was 39.1％ (54/138) while the attributable case fatality rate 31.9％ (44/138).Multivariate Logistic regression analysis indicated acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥20 points (OR =8.025,95％ CI:2.032-31.696,P =0.003),hypoproteinemia (OR =6.213,95％ CI:1.849-20.879,P =0.003),concurrent bacteremia (OR =5.541,95％ CI:1.576-19.487,P =0.008) and indwelling urethral catheter (OR =13.776,95％ CI:1.402-135.352,P =0.024) were the independent risk factors of candidemia-related mortality,while removal or replacement of central venous catheter (OR =0.231,59％ CI:0.075-0.716,P =0.011) and surgery within 30 days (OR =0.206,95％ CI:0.050-0.857,P =0.030) were the protective factors.Conclusions Candida albicans is the most common causative agent.The case fatality rate of candidemia has remained high.APACHE Ⅱ score ≥ 20 points,hypoproteinemia,indwelling urethral catheter and concurrent bacteremia are independent risk factors attributing to candidemia-related mortality while removal or replacement of central venous catheter and surgery within 30 days are the protective ones.