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目的:探讨院内获得性真菌血症的临床特点及预后危险因素。方法:回顾我院2008年1月1日至2012年9月30日连续的院内获得性真菌血症患者的临床资料,分析其发生率、真菌种类分布、药敏以及发生真菌血症后第28天和第12周病死率及影响因素。结果:在观察期内共入院患者353 907例,其中共117例次发生院内获得性真菌血症,发生率为3.31/万。其中,白念珠菌占36.8%,其次为近平滑念珠菌(18.8%)、热带念珠菌(13.7%)、光滑念珠菌(6.0%)、季也蒙念珠菌(6.0%)、克柔念珠菌(4.3%)、清酒念珠菌(4.3%),其他酵母样菌占5.1%。热带念珠菌血症与血液系统恶性肿瘤有关;克柔念珠菌、光滑念珠菌血症与机械通气及3个月内的抗真菌药物暴露史有关。白念珠菌和近平滑念珠菌对氟康唑的敏感率最高,分别为92.7%和95.5%。真菌血症发病后第28天及第12周的总病死率为27.4%及38.5%,不同菌种间病死率差异无统计学意义。第12周病死率年龄>65岁患者高于20~65岁及<20岁患者(P=0.032),内科、重症监护病房(ICU)患者高于外科患者(分别为40.0%、57.1%和20.0%,P=0.002)。结论:白念珠菌仍是院内获得性真菌血症的主要致病菌,但非白念珠菌血症已呈上升趋势;其发病因素呈多样性分布。内科和ICU来源的念珠菌血症患者的病死率仍然很高,经验性抗真菌药物使用仍需加强。
Objective: To investigate the clinical characteristics of acquired fungal exacerbation and prognostic risk factors. Methods: The clinical data of consecutive patients with nosocomial fungal exacerbation in our hospital from January 1, 2008 to September 30, 2012 were retrospectively analyzed. The incidence, the distribution of fungi, the drug susceptibility and the incidence of fungal sepsis after 28 Days and 12th week mortality and influencing factors. Results: A total of 353 907 patients were enrolled during the observation period, of which 117 were hospital acquired fungal exacerbations with a rate of 3.31 per 10,000. Among them, Candida albicans accounted for 36.8%, followed by Candida parapsilosis (18.8%), Candida tropicalis (13.7%), Candida glabrata (6.0%), Candida sencei (6.0%), Candida krusei (4.3%), Candida albicans (4.3%), other yeast-like bacteria accounted for 5.1%. Candida tropicalis is associated with hematological malignancies; Candida krusei, C. glabrata is associated with mechanical ventilation and the history of antifungal exposure within 3 months. Candida albicans and Candida parapsilosis were the most sensitive to fluconazole, 92.7% and 95.5% respectively. The total case fatality rates at the 28th and the 12th week after fungal episode were 27.4% and 38.5%, respectively. There was no significant difference in mortality among different strains. In the 12th week, mortality was higher in patients aged> 65 years than in patients aged 20-65 years and <20 years (P = 0.032), patients in medical and intensive care unit (ICU) were higher than those in surgical patients (40.0%, 57.1% and 20.0% %, P = 0.002). Conclusion: Candida albicans is still the main pathogen of nosocomial fungal exacerbation, but non-albicans bacteremia has been on the rise. The incidence of these pathogens is diverse. The mortality of patients with candidaemia from internal medicine and ICU is still high, and the use of empirical antifungal drugs needs to be strengthened.