摘要
目的探讨机械通气患者肺部念珠菌感染的危险因素及对其耐药的初步分析。方法回顾性分析我院114例机械通气超过48h的患者,分成肺部念珠菌感染病例组和非念珠菌感染对照组,统计学方法采用单因素(χ2检验)及多因素Logistic回归进行分析,根据药敏试验结果进行耐药分析。结果在研究病人中,有50例(占43.9%)发生肺部念珠菌感染,单因素和多因素Logistic回归分析结果显示:患2种以上基础病(OR=4.758,P=0.009)、频繁更换抗生素(OR=6.128,P=0.001)、血白蛋白低于25g(OR=15.829,P=0.011)是感染的独立危险因素,而预防性抗真菌治疗(OR=0.062,P=0.012)则是感染的保护因素。耐药分析显示白色念珠菌对大多数抗真菌药物敏感(100.0%),而非白色念珠菌对氟康唑(50.0%)、伊曲康唑耐药率(38.5%)较高。结论患者的基础情况差及频繁更换抗生素是呼吸机相关性肺部念珠菌感染主要危险因素,对其耐药性的分析有助于肺部念珠菌感染的诊治。
Objective To investigate the risk factors for pulmonary Candida infection in association with mechanical ventilation and analyze the drug resistance profile of the Candida species that cause the infection. Methods A retrospective analysis was conducted 114 patients receiving mechanical ventilation for over 48 h. According to the presence of pulmonary Carutida infections, these patients were divided into infected group （n=50, 43.9%） and non-infected group （64 cases）. Univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors for the infection, and drug sensitivity test was carried out to evaluate the drug resistance of the Candida species. Results Univariate analysis and multivariate logistic regression showed that the presence of at least two underlying diseases （0R=4.758, P=0.009）, frequent changes of antibiotics （OR=6.128, P=0.001）, and blood albumin below 25 g （OR= 15.829, P=0.011） were the independent risk factors for pulmonary Candida infection associated with mechanical ventilation, and prophylactic antifungal treatment （OR= 0.062, P=0.012） was a protective factor. Drug sensitivity test showed that Candida albicons was sensitive to most of the antifungal agents （100.0%）, but the non-albicans Candida species were resistant to fluconazol （50.0%） and Itraconazole （38.5%）. Conclusion Poor general conditions and frequent changes of antibiotics are the major risk factors for pulmonary Candida infection in patients receiving mechanical ventilation. Drug resistant analysis is helpful in the treatment of the infections.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2009年第1期57-59,共3页
Journal of Southern Medical University
基金
广东省名医建设工程基金(粤卫[2004]199号)
关键词
呼吸机相关性肺炎
危险因素
早期诊断
念珠菌耐药
ventilator-associated pneumonia
risk factors
early diagnosis
candidiasis, drug resistance
