Clinical analysis of 82 patients with candidemia

doi:10.3877/cma.j.issn.1674-1358.2017.04.012

Abstract

Abstract:

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.

Key words: Candidemia, Risk factors, Prognosis

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

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References 20

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念珠菌菌种	例数	构成比（%）
白念珠菌	35	42.7
近平滑念珠菌	18	22.0
热带念珠菌	16	19.5
光滑念珠菌	6	7.3
无名念珠菌	4	4.9
红酵母菌	2	2.4
皱落念珠菌	1	1.2

念珠菌菌种	例数	构成比（%）
白念珠菌	35	42.7
近平滑念珠菌	18	22.0
热带念珠菌	16	19.5
光滑念珠菌	6	7.3
无名念珠菌	4	4.9
红酵母菌	2	2.4
皱落念珠菌	1	1.2

病原菌	株数	敏感菌株
病原菌	株数	5-氟胞嘧啶	氟康唑	伊曲康唑	伏立康唑	两性霉素
白念珠菌	35	35（100.0）	30（85.7）	30（85.7）	30（85.7）	35（100.0）
近平滑念珠菌	18	18（100.0）	18（100.0）	16（88.9）	18（100.0）	18（100.0）
热带念珠菌	16	16（100.0）	12（75.0）	11（68.8）	11（68.8）	16（100.0）
光滑念珠菌	6	6（100.0）	6（100.0）	5（83.3）	6（100.0）	6（100.0）
无名念珠菌	4	4（100.0）	4（100.0）	4（100.0）	4（100.0）	4（100.0）
红酵母菌	2	2（100.0）	2（100.0）	2（100.0）	2（100.0）	2（100.0）
皱落念珠菌	1	1（100.0）	0（0.0）	1（100.0）	1（100.0）	1（100.0）

病原菌	株数	敏感菌株
病原菌	株数	5-氟胞嘧啶	氟康唑	伊曲康唑	伏立康唑	两性霉素
白念珠菌	35	35（100.0）	30（85.7）	30（85.7）	30（85.7）	35（100.0）
近平滑念珠菌	18	18（100.0）	18（100.0）	16（88.9）	18（100.0）	18（100.0）
热带念珠菌	16	16（100.0）	12（75.0）	11（68.8）	11（68.8）	16（100.0）
光滑念珠菌	6	6（100.0）	6（100.0）	5（83.3）	6（100.0）	6（100.0）
无名念珠菌	4	4（100.0）	4（100.0）	4（100.0）	4（100.0）	4（100.0）
红酵母菌	2	2（100.0）	2（100.0）	2（100.0）	2（100.0）	2（100.0）
皱落念珠菌	1	1（100.0）	0（0.0）	1（100.0）	1（100.0）	1（100.0）

危险因素	30 d生存结果		单因素分析		多因素分析
危险因素	存活	死亡	P值	统计量	P值	OR（95%CI）
年龄（岁）	64.22 ± 1.996	72.46 ± 3.542	0.005	t = 3.639	0.025	1.085（1.002～1.174）
肿瘤	16	12	0.051	χ² = 3.793
糖尿病	21	10	0.643	χ² = 0.215
肺部疾病	22	15	0.042	χ² = 4.138
腹腔感染性疾病	18	2	0.029	χ² = 4.744
贫血	46	20	0.676	χ² = 0.175
低蛋白血症	49	21	0.993	χ² = 0.000
中性粒细胞减少	7	8	0.023	χ² = 5.136
肾功能不全	7	8	0.023	χ² = 5.136
外科手术	40	9	0.008	χ² = 6.989
胃管	51	18	0.145	χ² = 2.128
尿管	49	17	0.156	χ² = 2.014
体腔引流	34	3	0.000	χ² = 14.582
深静脉置管	47	16	0.161	χ² = 1.969
呼吸机	24	11	0.711	χ² = 0.138
肠外营养	49	18	0.312	χ² = 1.021
输血	36	15	0.971	χ² = 0.001
激素	12	4	0.676	χ² = 0.175
抗菌药物	54	22	1.000	χ² = 0.000
抗菌药物使用> 1个月	18	13	0.049	χ² = 3.863
入住ICU治疗	35	19	0.102	χ² = 2.674
感染性休克	11	18	0.000	χ² = 23.318	0.045	14.33（5.065～92.800）
合并细菌血流感染	18	16	0.003	χ² = 8.880	0.041	12.8（8.106～48.190）

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