念珠菌血症：中国一家三级甲等学术医院的发病率、菌种类型及危险因素

Candidemia: incidence rates, type of species, and risk factors at a tertiary care academic hospital in China.

作者信息

Wu Zengbin, Liu Yingbin, Feng Xiaobo, Liu Ying, Wang Shuyun, Zhu Xiaodong, Chen Qiqi, Pan Shuming

机构信息

Emergency Department, Xinhua Hospital, Shanghai Jiaotong University Medical College, 1665 Kongjiang Road, Shanghai, China.

Department of Surgery, Xinhua Hospital, Shanghai Jiaotong University Medical College, Shanghai, China.

出版信息

Int J Infect Dis. 2014 May;22:4-8. doi: 10.1016/j.ijid.2013.11.011. Epub 2014 Feb 28.

DOI:10.1016/j.ijid.2013.11.011

PMID:24583564

Abstract

OBJECTIVES

To investigate the incidence rates of candidemia in hospitalized patients and to identify differences in risk factors of patients with Candida albicans and non-C. albicans and with Candida guilliermondii and non-C. guilliermondii candidemia.

METHODS

Non-immunosuppressed, non-neutropenic inpatients with candidemia diagnosed after admission were included in this retrospective observational study at a tertiary academic hospital in China.

RESULTS

During the study period (January 2009 to December 2011), 238 eligible patients had candidemia episodes with an incidence rate 5.4%. Of these patients, 29.8% had candidemia due to C. albicans, 27.7% due to C. parapsilosis, and 16.4% due to C. guilliermondii. Diabetes was a significant risk factor for patients with candidemia due to C. albicans (35.2%, 25/71) compared to candidemia due to non-C. albicans spp (13.2%, 22/167) (odds ratio (OR) 0.2792, 95% confidence interval (CI) 0.144-0.5412; p < 0.001). Compared to patients with candidemia due to non-C. guilliermondii spp, preterm birth with low birth weight (OR 0.0887, 95% CI 0.0398-0.1977; p < 0.001), intravenous nutrition (OR 0.0662, 95% CI 0.0226-0.1938), and surgery (OR 0.0662, 95% CI 0.0226-0.1938; p < 0.001) were significant risk factors for candidemia due to C. guilliermondii. Furthermore, compared to patients with candidemia due to C. albicans, patients with candidemia due to C. guilliermondii had markedly higher rates of central venous catheterization (85.9%, 61/71 vs. C. guilliermondii: 100%, 39/39; p = 0.013) and intravenous nutrition (89.7%, 35/39 vs. C. albicans: 42.2%, 30/71; p < 0.001).

CONCLUSIONS

Candidemia due to C. albicans ranks first in incidence, and candidemia due to C. guilliermondii occurs in a significant proportion of our hospitalized patients.

摘要

目的

调查住院患者念珠菌血症的发病率，并确定白色念珠菌与非白色念珠菌、季也蒙念珠菌与非季也蒙念珠菌引起的念珠菌血症患者的危险因素差异。

方法

本回顾性观察研究纳入了中国一家三级学术医院入院后诊断为念珠菌血症的非免疫抑制、非中性粒细胞减少的住院患者。

结果

在研究期间（2009年1月至2011年12月），238例符合条件的患者发生念珠菌血症，发病率为5.4%。其中，29.8%的患者念珠菌血症由白色念珠菌引起，27.7%由近平滑念珠菌引起，16.4%由季也蒙念珠菌引起。与非白色念珠菌属引起的念珠菌血症患者相比，糖尿病是白色念珠菌引起的念珠菌血症患者的一个显著危险因素（35.2%，25/71 vs. 13.2%，22/167）（比值比（OR）0.2792，95%置信区间（CI）0.144 - 0.5412；p < 0.001）。与非季也蒙念珠菌属引起的念珠菌血症患者相比，低出生体重早产（OR 0.0887，95% CI 0.0398 - 0.1977；p < 0.001）、静脉营养（OR 0.0662，95% CI 0.0226 - 0.1938）和手术（OR 0.0662，95% CI 0.0226 - 0.1938；p < 0.001）是季也蒙念珠菌引起的念珠菌血症的显著危险因素。此外，与白色念珠菌引起的念珠菌血症患者相比，季也蒙念珠菌引起的念珠菌血症患者的中心静脉置管率（85.9%（61/71）对季也蒙念珠菌：100%（39/39）；p = 0.013）和静脉营养率（89.7%（35/39）对白色念珠菌：42.2%（30/71）；p < 0.001）明显更高。