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中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (04) : 373 -376. doi: 10.3877/cma.j.issn.1674-1358.2017.04.012

临床论著

82例念珠菌血症患者的临床分析
陈玉1, 鲁俊锋2, 魏兵1, 周文波1, 杨强1, 聂秀红1,()   
  1. 1. 100054 北京,首都医科大学宣武医院呼吸科
    2. 100069 北京,首都医科大学附属北京佑安医院
  • 收稿日期:2017-03-26 出版日期:2017-08-15
  • 通信作者: 聂秀红
  • 基金资助:
    北京市医院管理局"青苗"计划专项经费资助(No. QML20151602)

Clinical analysis of 82 patients with candidemia

Yu Chen1, Junfeng Lu2, bing Wei1, Wenbo Zhou1, Qiang Yang1, Xiuhong Nie1,()   

  1. 1. Respiratory Department, Xuanwu Hospital Capital Medical University, Beijing 100054, China
    2. Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
  • Received:2017-03-26 Published:2017-08-15
  • Corresponding author: Xiuhong Nie
引用本文:

陈玉, 鲁俊锋, 魏兵, 周文波, 杨强, 聂秀红. 82例念珠菌血症患者的临床分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2017, 11(04): 373-376.

Yu Chen, Junfeng Lu, bing Wei, Wenbo Zhou, Qiang Yang, Xiuhong Nie. Clinical analysis of 82 patients with candidemia[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(04): 373-376.

目的

探讨念珠菌血症患者的病原体分布、基础疾病、危险因素及治疗预后。

方法

回顾性分析首都医科大学宣武医院2013年1月至2016年12月间念珠菌血症患者的临床资料。

结果

82例念珠菌血症患者中,白念珠菌感染者占42.7%,非白念珠菌感染者占57.3%,其中近平滑念珠菌感染者22.0%,热带念珠菌感染者19.5%;大多临床分离菌株体外对抗真菌药物敏感。入组患者主要基础疾病有肺部疾病(45.1%)、糖尿病(37.8%)和肿瘤(34.1%)。常见危险因素包括长期使用广谱抗菌药物(92.7%)、侵入性导管(87.8%)和肠外营养支持(81.7%)。30 d病死率为29.3%,年龄、感染性休克和合并细菌血流感染为30 d死亡的独立影响因素。

结论

念珠菌血症病原菌以非白念珠菌为主,大多数临床分离菌株体外对抗真菌药物敏感,患者常合并严重基础疾病,伴有多种危险因素,预后较差。临床上应早期识别高危患者,抢先治疗以改善患者预后。

Objective

To investigate the Candida species distribution, underlying diseases, risk factors and treatment outcome in patients with candidemia.

Methods

Clinical data of the patients with candidemia in Xuanwu Hospital, Capital Medical University from January 2013 to December 2016 were analyzed, retrospectively.

Results

Total of 82 episodes of Candidemia was identified. The proportion of candidemia caused by C. albicans and non-albicans species were 42.7% and 57.3%, which included C. parapsilosis (22.0%) and C. tropicalis (19.5%). The majority of the isolates were susceptible to anti-fungal agents in vitro. Pulmonary diseases (45.1%), diabetes mellitus (37.8%) and tumor (34.1%) were the main predisposing diseases. Broad-spectrum antibiotic use (92.7%), invasive catheter (87.8%) and parenteral alimentation (81.7%) were the major risk factors. The overall 30-day mortality was 29.3%. Age, septic shock and bacterial bloodstream infection were independent risk factors for 30-day mortality.

Conclusions

Non-albicans Candida was predominant in candidemia. Most clinical strains were sensitive to antifugal drugs in vitro. Patients were accompanied by a variety of risk factors, had severe underlying disease and poor prognosis. High-risk patients should be identified early clinically in order to treat timely and improve the prognosis.

表1 82例念珠菌血症菌种的分布
表2 临床分离念珠菌对常用抗真菌药的敏感性[株(%)]
表3 念珠菌血症患30 d死亡相关危险因素分析
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