ICU患者呼吸机相关肺部念珠菌感染的物种分布、药敏及患者死亡危险因素的分析

目的 呼吸机相关肺部念珠菌感染(VAPCI)是ICU患者死亡的重要因素之一,但目前数据有限。我们旨在通过研究了解梅州地区ICU VAPCI患者的流行病学,抗真菌治疗和患者死亡危险因素。方法 选择该地区3家三级医院2010年1月至2017年12月ICU中发生VAPCI的319例患者为研究对象,进行呼吸道标本培养,测定分离念珠菌菌株的抗菌敏感性,运用Logistic多元回归分析ICU VAPCI患者死亡的危险因素。结果 8年间ICU VAPCI的发生率为2.19%(319/14 597),病死率为53.29% (171/319); 319例患者分离共获得念珠菌菌株343株,其中白色念珠菌所占比例最高,达46.36%(159/343),其它依次为热带念珠菌、光滑念珠菌、近平滑念珠菌、克柔念珠菌和季也蒙念珠菌等非白念珠菌,合计占53.64%(184/343);药敏结果显示,6种念珠菌对5种常用抗真菌药物的敏感率除了光滑念珠菌对3种唑类药物敏感率略低于80%外,其他敏感率都高于80%,其中白色念珠菌的敏感率都高于90%;Logistic多元回归分析显示,年龄、恶性肿瘤、血清白蛋白、APACHEII评分、合并基础疾病≥ 3、导管留置时间和住ICU时间是VAPCI的独立的死亡危险因素;ROC分析显示,APACHEII评分大于19分和血清白蛋白低于或等于25 g/L是这两项独立危险因素的最佳预测值。结论 ICU VAPCI致病菌株以白色念珠菌为主,死亡率高,临床应重视对具备上述危险因素患者加强监测和真菌药敏监测,降低患者死亡率。

Ventilator associated pulmonary candida infection in intensive care units in the Meizhou region of China: species distribution and resistance,the risk factors for patient mortality and resistance,the risk factors for patient mortality

Ventilator associated pulmonary candida infectionsis (VAPCI) is one of the important factors in the death of ICU patients, but available datas are limited. Our objective was to characterize the fungal pathogens that cause ventilator?associated pneumonias(VAP) and determine the epidemiology and risk factors for patient mortality among ICU patients in Meizhou, China. Of 319 ICU patients with VAPCI during their stays were included in the study conducted in Meizhou region from January 2010 to December 2017. Blood cultures were performed and the antimicrobial susceptibility profiles of the resulting isolates were determined. Logistic multiple regression and receiver operating characteristics (ROC) curve analysis were used to assess the risk factors for mortality among the cases. Results showed that the prevalence of VAPCI in ICU patients was 2.19% (319/14,597) with a mortality rate of 53.29% (171/319). The 343 strains of VAP Candida spp. were identified from these patients. Candida albicans was most common (46.36%), others were Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida krusei, and Candida albicans. C. glabrata was less than 80% sensitive to azole drugs. Logistic multiple regression showed that age,malignant tumor,serum albumin, acute physiology and chronic health evaluation (APACHE) II score, three or more underlying diseases, catheter retention time,and length of stay in ICU were independent risk factors for mortality in VAPCI. ROC curve analysis showed that APACHE II scores >19 and serum albumin ≤25 g/L were the best predictors of mortality. In conclusio, C. albicans predominated in the patients of VAPCI in ICU, with high mortality. Thus, the clinical doctors should attach importance to the above risk factors of patients with enhanced monitoring and fungal susceptibility monitoring to reduce the mortality of patients.