摘要
目的了解院内深部真菌感染高危患者体内念珠菌的分离情况以及深部念珠菌感染发生的危险因素。方法采用前瞻性队列研究方法对血液科、老年科和 ICU 病房2004年5月至2005年4月入院的所有患者进行各种可能危险因素及深部念珠菌感染的监测。对出现深部念珠菌感染的患者和未出现深部念珠菌感染的患者进行比较,统计学分析采用非条件 Logistic 回归模型,分析深部念珠菌感染发生的危险因素。结果共入组440例患者,其中152例分离到426株念珠菌,白念珠菌占67.4%,其他念珠菌为32.6%。共61例患者出现定植,主要为白念珠菌。对资料完整的193例患者进行危险因素的多因素分析显示2种及2种以上广谱抗生素应用(OR=16.204;95%可信区间:2.005～130.980),念珠菌菌落定植(OR=10.636;95%可信区间:3.743～30.222)和应用尿管(OR=4.285;95%可信区间:1.399～13.127)是深部念珠菌感染发生的危险因素。结论深部真菌感染高危患者体内分离的念珠菌中白念珠菌仍居首位。深部念珠菌感染发生的危险因素依次为2种及2种以上广谱抗生素应用、念珠菌菌落定植和应用尿管。
Objective To study the distribution of Candida spp. in the patients with high-risk of fungal infection and the risk factors of deep candidiasis. Methods A prospective cohort study was performed among 440 consecutive hospitalized patients admitted to the hematology wards, geriatric wards, and ICUs from May 2004 to April 2005. Stool, urine, and saliva were cultured during the period 72-96 h after hospitalization for the first time and then once a week till the patient was discharged or by the end of the sixth week. If deep fungal infection was suspected culture of blood, sputum, bacterium-free body fluid, and/ or biopsy specimens were cultured. Medical records were reviewed to analyze the possible risk factors. Results 426 strains of Candida spp. were isolated from 152 patients, with Candida albicans accounting for 67.4% and other Candida spp for 32.6%. 61 patients were discovered to express Candida colonization. The major species isolated from patients with Candida colonization was Candida albicans. The risk factors identified included two or more broad-spectrum antibiotic administration （odds ratio 16. 204; 95% confidence interval, 2.005 to 130. 980）, Candida colonization （ 10. 636; 3. 743 to 30.222）, and urinary canal administration （4.285 ; 1. 399 to 13. 127） . Conclusion Candida albicans is still the major organism isolated from the high risk fungal infection patients. Two or more broad-spectrum antibiotic administration, Candida colonization, and urinary canal administration are proved to be the risk factors, with the broad- spectrum antibiotic administration exhibiting more influence than Candida colonization and urinary canal administration.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第42期2991-2993,共3页
National Medical Journal of China
关键词
念珠菌病
危险因素
前瞻性研究
Deep candidiasis
Risk factor
Prospective studies
