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目的:研究影响念珠菌血流感染的病原学分布及影响预后的危险因素。方法:回顾性分析2009-12-2013-01南京医科大学第一附属医院48例住院患者的念珠菌血流感染的病历资料。根据出院时的预后分为死亡组(16例)和存活组(32例),收集人口学资料、入住单元、基础疾病、有创操作、血培养菌株及耐药性、入院时急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭估计(SOFA)评分;通过多因素logistic回归分析确定影响念珠菌血流感染预后的危险因素。同时通过比较白色念珠菌与非白色念珠菌血流感染的差别,分析念珠菌血流感染病原学及耐药性特点与变化。结果:48例念珠菌血流感染患者中白色念珠菌14例(29.2%),非白色念珠菌34例(70.8%)。APACHEⅡ评分(OR 1.140,95%CI 1.016~1.279,P<0.05)与血清白蛋白低于25g/L(OR 25.565,95%CI 2.388~273.695,P<0.01)是念珠菌血流感染预后不佳的危险因素。结论:念珠菌血流感染的病原菌以非白色念珠菌为主,尤其是光滑念珠菌,念珠菌对氟康唑的耐药性较高。入院时APACHEⅡ评分、血清白蛋白(ALB)低于25g/L是念珠菌血流感染死亡的危险因素。
Objective: To study the etiological distribution of Candida infection and the prognostic risk factors. Methods: A retrospective analysis of 2009-12-2013-01 First Affiliated Hospital of Nanjing Medical University, 48 cases of hospitalized patients with Candida bloodstream infection medical records. According to the prognosis at discharge, the patients were divided into death group (16 cases) and survival group (32 cases). Demographic data, admission units, underlying diseases, invasive procedures, blood culture strains and drug resistance were collected. Acute physiology and chronic APACHE II score and SOFA score. Multivariate logistic regression analysis was used to determine the risk factors influencing the prognosis of Candida infection. At the same time, by comparing the differences between Candida albicans and non-Candida albicans bloodstream infections, the etiology and drug resistance of Candida bloodstream infection were analyzed. Results: Candida albicans was found in 14 of 48 (29.2%) and 34 (70.8%) non-Candida albicans in 48 cases of Candida infection. APACHEⅡscore (OR 1.140, 95% CI 1.016-1.279, P <0.05) and serum albumin less than 25g / L (OR 25.565,95% CI 2.388-273.695, P <0.01) were poor prognosis of Candida infection Risk factors. CONCLUSION: Candida albicans is the predominant pathogen of bloodstream infection in Candida albicans, especially Candida glabrata, while Candida albicans is more resistant to fluconazole. Admission APACHE Ⅱ score, serum albumin (ALB) less than 25g / L is a risk factor for Candida bloodstream infection death.