74例真菌血症流行病学及预后因素的回顾性分析

摘要

目的 回顾性分析真菌血症临床特征、易感因素和真菌流行病学特点,并探讨真菌血症死亡危险因素,为真菌血症临床治疗和院感控制提供依据.方法 收集我院2014年1月～2015年3月74例真菌血症患者临床资料,回顾性分析临床特征、病原菌分布、致病危险因素;单因素及Logistic多元回归分析存活组和死亡组,确定死亡危险因素.结果 真菌血症易感因素多,病死率高(74例真菌血症患者,死亡33例),念珠菌感染65例,为真菌血症主要病原菌.单因素分析显示患者高龄(≥60岁)、发生多器官功能衰竭、糖尿病、肺部感染、外科手术后或创伤和胃肠外营养这6项指标在存活组和死亡组间存在有统计意义的差异.Logistic回归分析显示发生多器官功能衰竭、外科手术后或创伤、糖尿病、胃肠外营养是死亡相关的独立危险因子.结论 念珠菌是真菌血症主要病原菌.发生多器官功能衰竭、外科手术后或创伤、糖尿病以及胃肠外营养可能是真菌血症患者死亡的独立危险因素.高度重视真菌病原学检查,早诊断,积极消除易感因素,及时、合理选用抗真菌药物是真菌血症成功治疗的关键.%Objective To analyze the incidence,clinical features and the predisposing factors of fungemia,and investigate the risk factors for death due to fungemia and guide clinical treatment and hospital control.Methods The data of predisposing factors,distribution of fungus,treatment and outcomes of 74 patients with fungemia from January 2014 to March 2015 were analysed,retrospectively.The clinical data of 74 patients with fungal disease were divided into survival group and death group.Based on the results of univariate analysis,the data were analyzed using logistic multiple regression,and then the significant differences of survival group and death group were compared.Results Fungemia had many predisposing factors with high mortality rate (33/74,44.6％).Candida was the most prevalent species isolated.Univariate analysis revealed significant differences between the cured/improved cases and the fatal cases for 6 variables,including advanced age,multiple organ dysfunction syndrome (MODS),diabetes,lung infection,surgery or trauma and parenteral nutrtion therapy.Logistic multiple regression analysis showed that MODS,diabetes,surgery or trauma and parenteral nutrtion therapy were the independent risk factors for fungal septicemia-related death.Conclusion Candida spp.wvere the major pathogens.MODS,diabetes,surgery or trauma and parenteral nutrition therapy were the independent risk factors for fungemia related death.Isolation of pathogens,antibiotic susceptibility test and correct choice of antifungal agents in high risk patients are critical for the management of patients with fungemia infection.