2011-2022年某三甲医院念珠菌/细菌混合血流感染的临床特征及危险因素

Clinical characteristics and risk factors for mixed bloodstream infection with Candida and bacteria in a three-A hospital from 2011 to 2022

  • 摘要: 目的 分析混合性与单纯性念珠菌血流感染在病原学、临床特征及预后方面的差异,并探讨混合感染的危险因素。方法 采用回顾性病例对照研究,收集2011年1月-2022年12月广东省人民医院收治的130例念珠菌血流感染患者临床资料,根据是否合并细菌感染分为混合感染组71例与单纯感染组59例。分析两组病原菌分布、基础疾病及预后情况,采用单因素及多因素logistic回归分析混合感染的危险因素。结果 单纯感染组以热带念珠菌(44.07%)和白色念珠菌(38.98%)为主; 混合感染组白色念珠菌检出率最高(40.85%),合并细菌以葡萄球菌属最常见(29.87%)。念珠菌血流感染总体院内病死率为51.5%(67/130),单纯念珠菌感染组病死率为54.24%(32/59),混合感染组为49.30%(35/71),两组间病死率差异无统计学意义。多因素logistic回归分析显示,年龄(OR=1.029,95%CI:1.002~1.057,P=0.036)、激素治疗(OR=14.217,95%CI:2.232~90.568,P=0.005)及呼吸机支持(OR=6.623,95%CI:1.016~43.150,P=0.048)是念珠菌合并细菌血流感染的独立危险因素,而慢性肝病是其保护因素(OR=0.047,95%CI:0.004~0.562,P=0.016)。结论 念珠菌血流感染病死率高,混合感染以白色念珠菌合并葡萄球菌属多见; 年龄、激素治疗及呼吸机支持是混合感染的独立危险因素。

     

    Abstract: OBJECTIVE To observe the differences in etiological, clinical characteristics and treatment outcomes between the mixed and simple bloodstream infection with Candida and explore the risk factors for the mixed infections. METHODS By means of retrospective case-control study, the clinical data were collected from 130 patients with Candida bloodstream infection who were treated in Guangdong Provincial People's Hospital from Jan. 2011 to Dec. 2022. The enrolled patients were divided into the mixed infection group with 71 cases and the simple infection group with 59 cases according to the status of bacterial infection complication. The distribution of pathogens, underlying diseases and treatment outcomes were observed and compared between the two groups. Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the mixed infections. RESULTS Candida tropicalis (44.07%) and Candida albicans (38.98%) were dominant in the simple infection group; the isolation rate of C. albican was highest (40.85%) in the mixed infection group, and the complication with bacterial and Staphylococcus spp was most common (29.87%). The overall nosocomial mortality rate of the patients with Candida bloodstream infection was 51.5%(67/130); the mortality rate was 54.24%(32/59) in the simple Candida infection group, 49.30%(35/71) in the mixed infection group, and there was no significant difference in the mortality rate between the two groups. The result of multivariate logistic regression analysis indicated that the age(OR=1.029,95%CI:1.002 to 1.057,P=0.036), hormonotherapy (OR=14.217,95%CI:2.232 to 90.568,P=0.005) and ventilator support(OR=6.623,95%CI:1.016 to 43.150,P=0.048) were the independent risk factors for the mixed bloodstream infections with Candida and bacteria, while the chronic liver disease was the protective factor(OR=0.047,95%CI:0.004 to 0.562,P=0.016). CONCLUSIONS The mortality rate of the patients with Candida bloodstream infection is high. The patients with the mixed infections of Candida and Staphylococcus spp are common. The age, hormonotherapy and ventilator support are the independent risk factors for the mixed infections.

     

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