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摘要:
目的 本研究旨在确定念珠菌血症的危险因素, 评估肿瘤患者中近平滑假丝酵母菌和其他念珠菌之间可能存在的临床显著性差异。并对白假丝酵母菌血症和近平滑假丝酵母菌血症的临床特点及危险因素进行统计学分析, 旨在通过该类分析, 及时开展干预, 尽量避免易感因素, 进而改善真菌血症患者预后。 方法 回顾性分析郑州大学附属肿瘤医院2012年3月至2018年2月323例念珠菌血症患者的资料。分析患者发生念珠菌血症的危险因素, 同时对比分析近平滑假丝酵母菌和非近平滑假丝酵母菌、白假丝酵母菌和非白假丝酵母菌念珠菌血症的临床差异。通过微量肉汤稀释法对念珠菌常见抗真菌药物进行药敏试验和分析。 结果 念珠菌血症分离病原体中, 最常见的为近平滑假丝酵母菌37.15%（120/323）, 而白假丝酵母菌占34.37%。多变量回归分析结果表明, 下述因素与近平滑假丝酵母菌念珠菌血症的发生相关, 即肠外营养（P < 0.001）、粒缺（P < 0.001）、化疗（P < 0.001）和抗真菌药物的使用（P < 0.001）, 同时肠外营养为近平滑假丝酵母菌念珠菌血症发生的独立危险因素（OR=0.183, 95%CI:0.098~ 0.340;P < 0.001）。 结论 近平滑假丝酵母菌超越白假丝酵母菌为患者念珠菌血症主要病原体。通过评估患者念珠菌血症发生的可能危险因素, 以期加强和制定感染控制策略, 从而预防念珠菌血症的传播。 Abstract:Objects To clarify the risk factors of candidemia and to assess the clinical differences that may exist between infection with Candida parapsilosis and that with other Candida species in cancer patients. To statistically analyze the clinical characteristics of Candida albicans candidemia and C. parapsilosis candidemia and risk factors for their infections. We aimed at a timely intervention through this type of analysis to avoid susceptible factors and improve the prognosis of patients with candidemia. Methods We retrospectively included 323 patients with candidemia in Affiliated Cancer Hospital of Zhengzhou University between March 2012 and February 2018 and analyzed the clinical characteristics of these patients to establish the risk factors of candidemia. We performed a comparative analysis of the clinical characteristics of C. parapsilosis infections and non-parapsilosis Candida spp. infections and of C. albicans infections and non-albicans Candida spp. infections. In addition, drug sensitivity tests and analyses were performed with the common antifungal drugs used in Candida infections by a micro-broth dilution method. The statistical software SPSS version 22 was used for the analyses. Results A total of 323 patients were enrolled and analyzed in this study. Of the isolates, 34.37% were C. albicans and 65.63% were non-albicans Candida spp. Multivariate regression analysis showed that the following factors were associated with the occurrence of C. parapsilosis candidemia: parenteral nutrition (P < 0.001), neutropenia (P < 0.001), history of receiving chemotherapy (P=0.002), and history of previous antifungal use (P < 0.001). Parenteral nutrition was found to be an independent risk factor for C. albicans candidemia (OR=0.183; 95%CI:0.098-0.340; P < 0.001). Conclusions C. parapsilosis was found to be the primary pathogen in cancer patients with candidemia. Total parenteral nutrition in the intensive care unit at diagnosis and abdominal surgery were independent risk factors of candidemia, and parenteral nutrition was an independent risk factor of C. parapsilosis candidemia. At present, C. parapsilosis is surpassing C. albicans as the main pathogen of candidemia in cancer patients at our hospital. This study emphasizes the need to assess the possible risk factors for candidemia in cancer patients and aims at strengthening and developing a hospital-based control strategy to prevent the spread of candidemia. -
Key words:
- candidemia /
- malignancy /
- C.albicans /
- C.parapsilosis
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表 1 323例肿瘤患者真菌血症特征
表 2 非近平滑假丝酵母菌血症和近平滑假丝酵母菌血症相关因素分析
表 3 常见念珠菌菌株抗真菌药物敏感试验
表 4 单变量分析肿瘤患者真菌血症30天死亡率
表 5 多变量分析肿瘤患者真菌血症30天死亡率
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