切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 47 -53. doi: 10.3877/cma.j.issn.1674-1358.2022.01.007

短篇论著

侵袭性念珠菌感染者临床特征、病原菌分布和感染指标分析
冯强生1, 宋月娟1,(), 哈小琴1, 高保东1   
  1. 1. 730050 兰州市,联勤保障部队第九四零医院检验科
  • 收稿日期:2021-04-18 出版日期:2022-02-15
  • 通信作者: 宋月娟

Clinical characteristics, pathogen distribution and infection biomarkers of patients with invasive Candida infection

Qiangsheng Feng1, Yuejuan Song1,(), Xiaoqin Ha1, Baodong Gao1   

  1. 1. Department of Clinical Laboratory, the 940th Hospital of Joint Logistics Support Force of People’s Liberation Army, Lanzhou 730050, China
  • Received:2021-04-18 Published:2022-02-15
  • Corresponding author: Yuejuan Song
引用本文:

冯强生, 宋月娟, 哈小琴, 高保东. 侵袭性念珠菌感染者临床特征、病原菌分布和感染指标分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2022, 16(01): 47-53.

Qiangsheng Feng, Yuejuan Song, Xiaoqin Ha, Baodong Gao. Clinical characteristics, pathogen distribution and infection biomarkers of patients with invasive Candida infection[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(01): 47-53.

目的

分析侵袭性念珠菌感染者的临床特征、病原菌分布和感染指标,为侵袭性念珠菌感染者的病原学诊断和治疗提供一定的依据。

方法

回顾性分析2016年1月至2021年1月联勤保障部队第九四零医院收治的151例侵袭性念珠菌感染者(感染组)临床特征、病原菌分布及其感染相关指标等,以200例非感染性疾病住院患者作为对照组。两组患者降钙素原(PCT)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)、白细胞(WBC)计数、中性粒细胞比(NEU%)、D-二聚体(D-Dimer)、1,3-β-D葡聚糖和肌钙蛋白Ⅰ(CTnⅠ)水平均为非正态分布计量资料,采用中位数(四分位数)表示,采用非参数检验Mann-Whitney U检验。

结果

感染组151例患者中男/女为1.7,平均年龄为(60.1 ± 18.4)岁,住院病死率为42.2%(49/116),本院发病率为42.9/100 000/年。151例侵袭性念珠菌感染者分离的主要病原菌以白色念珠菌为主[84例(55.6%)],其次为光滑念珠菌[15例(9.9%)]和热带念珠菌[13例(8.6%)];真菌合并细菌感染者占45.9%(62/135)。药敏试验结果显示,所分离病原菌对氟康唑、伊曲康唑、伏立康唑、5-氟胞嘧啶和两性霉素未表现出获得性耐药。患者标本来源主要为血[38例(25.2%)]、腹水[37例(24.5%)]和腹腔引流液[23例(15.2%)]等。住院科室以ICU[59例(39.1%)]为主,其次为普通外科[22例(14.6%)]和肝胆外科[18例(11.9%)]。患者主要临床诊断为脓毒症[18例(11.9%)]、肠穿孔[15例(9.9%)]、腹腔感染[11例(7.3%)]、胆管癌[11例(7.3%)]和血液病[11例(7.3%)]等32种常见疾病。侵袭性念珠菌感染者中血清1,3-β-D葡聚糖阳性者占66.7%(56/84),该56例患者1,3-β-D葡聚糖水平为266.1(167.0,286.0)pg/ml;CTnⅠ阳性患者30例,阳性率为19.9%(30/151),该30例患者CTnⅠ水平为0.35(0.05,0.24)μg/L。感染组患者感染相关指标(PCT、IL-6、CRP、WBC、NEU%和D-Dimer)与对照组差异均有统计学意义(Z = 10.70、6.33、7.27、8.50、11.74、8.01,P均< 0.001)。

结论

侵袭性念珠菌感染者病情危重、病死率高,病原菌以白色念珠菌为主,患者主要见于血流感染和腹腔感染,且部分患者伴CTnⅠ升高。

Objective

To investigate the clinical characteristics, pathogen distribution and infection biomarkers of patients with invasive Candida infection, and to provide theoretical basis for etiological diagnosis and treatment.

Methods

Total of 151 patients with invasive Candida infection (infection group) in the 940th Hospital of Joint Logistics Support Force of People’s Liberation Army from January 2016 to January 2021 were enrolled, retrospectively; the clinical characteristics, pathogen distribution and infection biomarkers of those patients were analyzed, while 200 patients with non-infection were collected as control group. The levels of procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP), white blood cell (WBC), neutrophil ratio (NEU%), D-dimer, 1, 3-β-D-glucan and cardiac troponin Ⅰ(CTnⅠ) of patients in infection group and control group were non-normally distributed, data were expressed by M (P25, P75), and analyzed by Mann Whitney U test.

Results

Among the 151 patients of infection group, male/female was 1.7, the median age was (60.1 ± 18.4) years old, the fatality rate was 42.2% (49/116), the incidence rate was 42.9/10 0000/year. Among the 151 cases with invasive Candida infection, 84 cases (55.6%) were with Candida albicans infection, followed by 15 cases (9.9%) with Candida glabrata infection, 13 cases (8.6%) with Candida tropicalis and 62 cases (45.9%) with fungi and bacterial infection. The results of antimicrobial susceptibility test showed that the isolated pathogens were without acquired resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin. The main sources of specimens were blood [38 cases (25.2%)], ascites [37 cases (24.5%)] and abdominal drainage fluid [23 cases (15.2%)]. The inpatient departments were dominated in ICU [59 cases (39.1%)], followed by department of general surgery [22 cases (14.6%)] and department of hepatobiliary surgery [18 cases (11.9%)]. The main clinical diagnosis were 32 kinds of common diseases, including sepsis [18 cases (11.9%)], intestinal perforation [15 cases (9.9%)], abdominal infection [11 cases (7.3%)], cholangiocarcinoma [11 cases (7.3%)] and hematological diseases [11 cases (7.3%)], etc. The positive rate of serum 1, 3-β-D-glucan accounted for 66.7% (56/84) of patients with invasive Candida infection, with the level of 266.1 (167.0, 286.0) pg/ml. The positive rate of CTnⅠ accounted for 19.9% (30/151), with the level of 0.35 (0.05, 0.24) μg/L. Compared with the control group, PCT, IL-6, CRP, WBC, NEU% and D-dimer were all significantly different of patients in infection group (Z = 10.70, 6.33, 7.27, 8.50, 11.74, 8.01; all P < 0.001).

Conclusions

Patients with invasive Candida infection were with critical condition and high mortality, Candida albicans was the main pathogen. Patients were mainly found with bloodstream infection and abdominal infection. CTnⅠ increased in some patients with invasive Candida infection.

表1 两组研究对象的一般资料
表2 200例非侵袭性念珠菌感染住院患者的主要临床诊断
表3 151例侵袭性念珠菌感染者的病原菌分布
表4 151例侵袭性念珠菌感染者的标本来源
表5 151例侵袭性念珠菌感染者的科室分布
表6 151例侵袭性念珠菌感染者的临床诊断
[1]
胡必杰,潘珏,高晓东, 译. 哈里森感染病学[M]. 上海科技出版社, 2019:925-929.
[2]
Michael A Pfaller, Daniel J Diekema, Daniel J Diekema. Epidemiology of invasive Mycoses in North America[J]. Crit Rev Microbiol,2010,36(1):1-53.
[3]
中华医学会外科学分会外科感染与重症医学学组,中国医师协会外科医师分会肠瘘外科医师专业委员会. 中国腹腔感染诊治指南(2019版)[J]. 中国实用外科杂志,2020,40(1):1-16.
[4]
吉凯强,臧彬. 侵袭性念珠菌病的诊治[J]. 实用药物与临床,2009,12(5):305-307.
[5]
Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium[J]. Clin Infect Dis,2020,71(6):1367-1376.
[6]
周颖杰,李光辉编译. 念珠菌病处理临床实践指南--美国感染病学会2009年更新[J]. 中国感染与化疗杂志,2009,9(3):161-167.
[7]
中华医学会外科学分会外科感染与重症医学学组,中国医师协会外科医师分会肠瘘外科医师专业委员会. 中国腹腔感染诊治指南(2019版)[J]. 中国实用外科杂志,2020,40(1):1-16
[8]
Clinical & Laboratory Standards Institute (CLSI). Reference method for dilution antifungal susceptibility testing of yeasts. CLSI document M27-A3[S]. PA:CLSI.2008:4.
[9]
王辉译主编. 临床微生物手册[M]. 11版. 中华电子音像出版社,2017,1686-1687.
[10]
郭凤梅,杨毅,邱海波. 中国重症患者侵袭性念珠菌感染的流行病学特征[J]. 中华内科杂志,2014,53(6):491-492.
[11]
陈玉,鲁俊锋,魏兵, 等. 82例念珠菌血症患者的临床分析[J/CD]. 中华实验和临床感染病杂志(电子版),2017,11(4):373-376.
[12]
杨靖娴,邵冬华,郭莉娜, 等. 北京某医院侵袭性念珠菌感染的菌株分布及药敏分析[J]. 中国真菌学杂志,2020,15(6):359-363, 370.
[13]
Pfaller MA, Castanheira M, Sader HS, et al. Evaluation of the activity of fusidic acid tested against contemporary Gram-positive clinical isolates from the USA and Canada[J]. Int J Antimicrob Agents,2010,35(3):282-287.
[14]
王贵强. 中国成人念珠菌病诊断与治疗专家共识[J]. 中华传染病杂志,2020,12(1):29-43.
[15]
Campion EW, Kullberg BJ, Arendrup MC. Invasive Candidiasis[J]. N Engl J Med,2015,373(15):1445-1456.
[16]
代晓明,时坤,吴向东, 等. 腹腔感染病原菌分布与细菌耐药性监测研究(附310例报告)[J]. 中国实用外科杂志,2016,36(2):73-78.
[17]
冯强生,宋月娟,哈小琴, 等. 2012年-2015年血培养标本病原微生物分布特征及血流感染患者感染指标分析[J]. 中国卫生检验杂志,2016,26(14):2032-2035.
[18]
任建安,吴秀文. 中国腹腔感染诊治指南(2019版)[J]. 中国实用外科杂志,2020,40(1):1-16.
[19]
Held J, Kohlberger I, Rappold E, et al. Comparison of (1, 3)-β-D-glucan, mannan/anti-mannan antibodies, and Cand-Tec Candida antigen as serum biomarkers for candidemia[J]. J Clin Microbiol,2013, 51(4):1158-1164.
[20]
马蕾,钟沂芮,刘林, 等. 造血干细胞移植后侵袭性真菌病临床特点及危险因素分析[J]. 第三军医大学学报,2020,42(17):1735-1742.
[21]
Ostrosky-Zeichner L, Alexander BD, Kett DH, et al. Multicenter clinical evaluation of the (1, 3) -D-glucan assay as an aid to diagnosis of fungal infections in humans[J]. Clin Infect Dis,2005,41(5):654-659.
[22]
林赋桂,闫亚芳,刘小芳, 等. 1, 3-β-D-葡聚糖与抗白假丝酵母生殖管抗体对侵袭性假丝酵母菌病诊断价值评估[J]. 中国微生态学杂志,2020,32(5):19-23, 29.
[23]
伍志通. G试验在侵袭性念珠菌病中的临床价值[J/CD]. 中西医结合心血管病电子杂志,2020,8(19):84, 90.
[24]
张建团. 心脏真菌病--系统性真菌病心肌损害的组织病理学研究[J]. 国外医学·皮肤病学分册,1991(6):383-384.
[25]
姜月红,李晓林,孙健, 等. 血浆(1, 3)-β-D葡聚糖及C-反应蛋白对真菌性血流感染的评价作用[J]. 中国医药科学,2019,9(3):9-12.
[26]
应芙蓉,陈约慧,石亮, 等. 血浆(1, 3)-β-D-葡聚糖及血清降钙素原等炎性指标在真菌性血流感染中的作用[J]. 中国卫生检验杂志,2017,27(4):563-566.
[27]
王凯飞. 降钙素原及血培养阳性时间对念珠菌血流感染的诊断价值及近平滑念珠菌的快速鉴定[D]. 军医进修学院解放军总医院,2012.
[28]
刘又宁,解立新. 感染相关生物标志物临床意义解读专家共识[J]. 中华结核和呼吸杂志,2017,40(4):243-257.
[1] 曹楣汾, 李琼, 凌花, 陆勇, 戴新贵. RETRA评分在ICU收治创伤患者中的应用[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(02): 130-135.
[2] 奚卫, 王闻卿, 刘玥, 王亚楠, 许学斌. 胃肠炎继发脓毒症感染创伤弧菌ST14514的病原学诊断与文献病例回顾分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 293-302.
[3] 袁丹, 钟潇, 王明松, 贾康. 脊髓损伤神经源性膀胱患者间歇导尿期间尿路感染病原菌分布及影响因素[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 229-236.
[4] 朱琳, 陈韬, 张慎, 许东. 华中地区某三甲医院感染科近十年病原菌结构及耐药性变迁[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(02): 75-82.
[5] 高旭, 李若凡, 孙立新, 刘佐军, 田广健. Miles手术中预置腹膜前补片预防造口旁疝的效果及安全性[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 266-272.
[6] 邢嘉翌, 龚佳晟, 祝佳佳, 陆群. 肺癌化疗患者继发肺部感染的病原菌耐药性及炎症因子变化分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 714-718.
[7] 李跃, 万玉峰, 何远强, 伏冉, 郑玉龙. 慢性共病患者并发医院获得性肺炎的病原菌分布及影响因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 446-449.
[8] 林科灿, 罗柳平. 肝胰十二指肠切除术在胆囊癌和胆管癌应用中的关键问题[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 774-778.
[9] 杨明, 张金珠, 王锡山. 全国肿瘤登记中心发布的2013年至2022年结直肠癌流行数据趋势解读[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(03): 177-181.
[10] 蒋坤寅, 韩少宇, 郝成俊, 杨峰, 张振清. 老年髋部骨折术后心脏不良事件的影响因素研究[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(02): 96-102.
[11] 周润奭, 郑敏, 韩伟, 李尊柱, 何朝凯, 池熠, 隆云. 目标导向的集束化护理策略对多重耐药菌所致感染性休克患者28 d预后的影响[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 236-242.
[12] 宋韵韵, 孙元慧, 黄登超, 郭秦乐, 高兰, 李昊, 石秦东. 危重症患者CRRT过程中低磷血症发生与预后的回顾性研究[J/OL]. 中华重症医学电子杂志, 2024, 10(02): 164-172.
[13] 周建芳, 罗旭颖, 张琳琳, 李宏亮, 杨燕琳, 陈光强, 石广志. 开颅术后危重患者急性肾损伤的发病率、危险因素及其对预后的影响[J/OL]. 中华重症医学电子杂志, 2024, 10(02): 148-156.
[14] 李文哲, 王毅, 崔建, 郑启航, 王靖彦, 于湘友. 新疆维吾尔自治区重症患者急性肾功能异常的危险因素分析[J/OL]. 中华卫生应急电子杂志, 2024, 10(05): 269-276.
[15] 刘晴雯, 韩勇, 陈丽丹, 邓哲. 早期机械通气对成人院内心脏骤停病死率的影响:一项回顾性队列研究[J/OL]. 中华卫生应急电子杂志, 2024, 10(04): 203-206.
阅读次数
全文


摘要