获得性免疫缺陷综合征合并细菌或真菌性血流感染166例临床分析

摘要

Objective To compare the clinical characteristics and outcomes of bacterial and fungal bloodstream infections in the patients with acquired immunodeficiency syndrome (AIDS). Methods The clinical data of AIDS patients complicated with bacterial or fungal bloodstream infection treated in Chongqing Public Health Medical Center from January 2016 to June 2018 were analyzed retrospectively. The two groups of patients were compared in terms of clinical symptoms, laboratory tests and outcomes. Results Significantly more patients in bacterial group (AIDS complicated with bacterial bloodstream infection) were associated with intravenous drug abuse than that in fungal group (AIDS complicated with fungal bloodstream infection) (P＜0.05). The average age of patients was older in bacterial group than in fungal group. The incidence of nausea, vomiting and skin rash in fungal group was significantly higher than that in bacterial group (P＜0.05). CD4+T cells in fungal group decreased more significantly than that in bacterial group. No significant difference was found between the two groups in sex ratio, routine blood tests, biochemical assays, and mortality. Conclusions Fungi are the main pathogen of AIDS-associated bloodstream infections. Contrast to the bacterial bloodstream infections in AIDS patients, fungal bloodstream infection is more frequently found in younger patients, and associated with higher incidence of nausea, vomiting, typical skin rash, and more remarkable decrease of CD4+T cells. Bacterial bloodstream infection is more prevalent than fungal bloodstream infection in intravenous drug abusers. No significant difference is found in the mortality between the AIDS patients complicated with bacterial bloodstream infection and those complicated with fungal bloodstream infection.%目的 对比获得性免疫缺陷综合征(AIDS)合并细菌性血流感染与真菌性血流感染的临床特征及预后.方法 回顾性分析2016年1月1日-2018年6月1日重庆市公共卫生医疗救治中心收治的AIDS合并细菌性血流感染患者和真菌性血流感染患者临床资料,比较两种患者在症状与体征、实验室检查及预后方面的差异.结果 AIDS合并细菌性血流感染患者(细菌组)中静脉药瘾人数所占比例明显高于AIDS合并真菌性血流感染患者(真菌组)(P＜0.05);细菌组患者平均年龄稍大于真菌组(P＜0.05);真菌组患者的恶心、呕吐及特征性皮疹的发生率明显高于细菌组(P＜0.05);真菌组CD4+T细胞降低较细菌组更为显著(P＜0.05).两组患者在性别、血常规、生化、病死率等方面无明显差异.结论 AIDS患者合并血流感染病原菌构成以真菌为主.真菌性血流感染患者年龄相对较小,更容易出现恶心、呕吐和特征性皮疹,且CD4+T细胞计数下降更为明显.而AIDS合并细菌性血流感染在静脉药瘾人群中发病率更高.两组患者病死率无明显差异.