侵袭性念珠菌感染者临床特征、病原菌分布和感染指标分析

目的:分析侵袭性念珠菌感染者的临床特征、病原菌分布和感染指标,为侵袭性念珠菌感染者的病原学诊断和治疗提供一定的依据。方法:回顾性分析2016年1月至2021年1月联勤保障部队第九四零医院收治的151例侵袭性念珠菌感染者(感染组)临床特征、病原菌分布及其感染相关指标等,以200例非感染性疾病住院患者作为对照组。两组患者降钙素原(PCT)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)、白细胞(WBC)计数、中性粒细胞比(NEU%)、D-二聚体(D-Dimer)、1,3-β-D葡聚糖和肌钙蛋白Ⅰ(CTnⅠ)水平均为非正态分布计量资料,采用中位数(四分位数)表示,采用非参数检验Mann-Whitney U检验。结果:感染组151例患者中男/女为1.7,平均年龄为(60.1±18.4)岁,住院病死率为42.2%(49/116),本院发病率为42.9/100000/年。151例侵袭性念珠菌感染者分离的主要病原菌以白色念珠菌为主84例(55.6%)],其次为光滑念珠菌15例(9.9%)]和热带念珠菌13例(8.6%)];真菌合并细菌感染者占45.9%(62/135)。药敏试验结果显示,所分离病原菌对氟康唑、伊曲康唑、伏立康唑、5-氟胞嘧啶和两性霉素未表现出获得性耐药。患者标本来源主要为血38例(25.2%)]、腹水37例(24.5%)]和腹腔引流液23例(15.2%)]等。住院科室以ICU59例(39.1%)]为主,其次为普通外科22例(14.6%)]和肝胆外科18例(11.9%)]。患者主要临床诊断为脓毒症18例(11.9%)]、肠穿孔15例(9.9%)]、腹腔感染11例(7.3%)]、胆管癌11例(7.3%)]和血液病11例(7.3%)]等32种常见疾病。侵袭性念珠菌感染者中血清1,3-β-D葡聚糖阳性者占66.7%(56/84),该56例患者1,3-β-D葡聚糖水平为266.1(167.0,286.0)pg/ml;CTnⅠ阳性患者30例,阳性率为19.9%(30/151),该30例患者CTnⅠ水平为0.35(0.05,0.24)μg/L。感染组患者感染相关指标(PCT、IL-6、CRP、WBC、NEU%和D-Dimer)与对照组差异均有统计学意义(Z=10.70、6.33、7.27、8.50、11.74、8.01,P均<0.001)。结论:侵袭性念珠菌感染者病情危重、病死率高,病原菌以白色念珠菌为主,患者主要见于血流感染和腹腔感染,且部分患者伴CTnⅠ升高。

Clinical characteristics,pathogen distribution and infection biomarkers of patients with invasive Candida infection

ObjectiveTo investigate the clinical characteristics, pathogen distribution and infection biomarkers of patients with invasive Candida infection, and to provide theoretical basis for etiological diagnosis and treatment. MethodsTotal of 151 patients with invasive Candida infection (infection group) in the 940th Hospital of Joint Logistics Support Force of People’s Liberation Army from January 2016 to January 2021 were enrolled, retrospectively; the clinical characteristics, pathogen distribution and infection biomarkers of those patients were analyzed, while 200 patients with non-infection were collected as control group. The levels of procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP), white blood cell (WBC), neutrophil ratio (NEU%), D-dimer, 1, 3-β-D-glucan and cardiac troponin Ⅰ(CTnⅠ) of patients in infection group and control group were non-normally distributed, data were expressed by M (P25, P75), and analyzed by Mann Whitney U test. ResultsAmong the 151 patients of infection group, male/female was 1.7, the median age was (60.1 ± 18.4) years old, the fatality rate was 42.2% (49/116), the incidence rate was 42.9/10 0000/year. Among the 151 cases with invasive Candida infection, 84 cases (55.6%) were with Candida albicans infection, followed by 15 cases (9.9%) with Candida glabrata infection, 13 cases (8.6%) with Candida tropicalis and 62 cases (45.9%) with fungi and bacterial infection. The results of antimicrobial susceptibility test showed that the isolated pathogens were without acquired resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin. The main sources of specimens were blood 38 cases (25.2%)], ascites 37 cases (24.5%)] and abdominal drainage fluid 23 cases (15.2%)]. The inpatient departments were dominated in ICU 59 cases (39.1%)], followed by department of general surgery 22 cases (14.6%)] and department of hepatobiliary surgery 18 cases (11.9%)]. The main clinical diagnosis were 32 kinds of common diseases, including sepsis 18 cases (11.9%)], intestinal perforation 15 cases (9.9%)], abdominal infection 11 cases (7.3%)], cholangiocarcinoma 11 cases (7.3%)] and hematological diseases 11 cases (7.3%)], etc. The positive rate of serum 1, 3-β-D-glucan accounted for 66.7% (56/84) of patients with invasive Candida infection, with the level of 266.1 (167.0, 286.0) pg/ml. The positive rate of CTnⅠ accounted for 19.9% (30/151), with the level of 0.35 (0.05, 0.24) μg/L. Compared with the control group, PCT, IL-6, CRP, WBC, NEU% and D-dimer were all significantly different of patients in infection group (Z = 10.70, 6.33, 7.27, 8.50, 11.74, 8.01; all P < 0.001). ConclusionsPatients with invasive Candida infection were with critical condition and high mortality, Candida albicans was the main pathogen. Patients were mainly found with bloodstream infection and abdominal infection. CTnⅠ increased in some patients with invasive Candida infection.