急诊危重症患者真菌感染的菌种和药敏分析及其易感因素研究OACSTPCD
Strain distribution and susceptibility,susceptible factors analysis of acute and critical patients with fungal infection
目的 探讨急诊危重症患者侵袭性真菌病(invasive fungal disease,IFD)的病原学分布和药敏分析及易感因素,以期为危重症患者的临床治疗及院感监测提供科学依据.方法 回顾性纳入中国人民解放军空军军医大学第一附属医院急诊科2018年1月-2023年1月急诊科危重症患者272例,根据是否发生真菌感染分为观察组(n=136)和对照组(n=136).统计观察组真菌感染的菌种分布和药敏分析情况,收集比较两组患者临床资料,采用logistic回归分析危重症患者真菌感染的易感因素,根据受试者工作特征曲线(receiver operating characteristic curve,ROC)评估预测变量的准确性.结果 观察组共检测出136株病原真菌,以白念珠菌为主,病原菌药敏分析结果与临床经验用药相符.logistic多因素分析显示,体质量(OR=0.171)、年龄(OR=1.118)、住院时间(OR=1.293)、机械通气时间(OR=2.116)、留置尿管(OR=0.329)、入院血糖(OR=1.652)、C反应蛋白(OR=2.321)、腹膜透析(OR=0.081)是急诊危重症患者发生IFD的独立危险因素(P＜0.05).ROC曲线分析显示:联合预测评估危重症患者继发IFD情况的曲线下面积(area under curve,AUC)=0.951,95％CI为0.916～0.987,灵敏度为0.873,特异度为0.948;与Az=0.5相比,差异具有统计学意义(P＜0.05).结论 急诊危重症患者真菌感染的主要致病菌种为白念珠菌,药敏分析结果与临床经验用药相符,体质量、年龄、住院时间、机械通气时间、留置尿管、入院血糖、C反应蛋白、腹膜透析是急诊危重症患者发生IFD的独立危险因素.
Objective To investigate the pathogenic distribution,drug sensitivity analysis and susceptibility factors of inva-sive fungal disease(IFD)in emergency patients with severe illness,in order to provide scientific basis for clinical treatment and hospital sensitivity monitoring of patients with severe illness.Methods A total of 272 critically ill patients in the emer-gency department of the First Affiliated Hospital of PLA Air Force Medical University from January 2018 to January 2023 were retrospectively included,and divided into observation group(n=136)and control group(n=136)according to whether fungal infection occurred.The strain distribution and drug susceptibility analysis of fungal infection in the observation group were statistically analyzed.Clinical data of patients in the two groups were collected and compared.The accuracy of the pre-dictors was assessed according to the receiver operating characteristic curve(ROC).Results A total of 136 pathogenic fun-gal strains were detected in the observation group,mainly Candida albicans.The results of drug susceptibility analysis were consistent with clinical experience.Logistic multivariate analysis showed that body mass(OR=0.171),age(OR=1.118),length of hospital stay(OR=1.293),duration of mechanical ventilation(OR=2.116),indignant catheter(OR=0.329),admission blood glucose(OR=1.652),C-reactive protein(OR=2.321),peritoneal dialysis(OR=0.081)were independent risk factors for IFD in emergency critically ill patients(P＜0.05).ROC curve analysis showed that the area under curve(AUC)for joint prediction and evaluation of secondary IFD in critically ill patients was 0.951,95％CI was 0.916-0.987,sensitivity was 0.873,and specificity was 0.948.Compared with Az=0.5,the difference was statistically significant(P＜0.05).Conclusion Candida albicans is the main pathogen causing fungal infection in emergency critically ill patients.The results of drug sensitivity analysis were consistent with clinical experience.Body weight,age,hospital stay,mechanical ven-tilation time,indignant urinary tube,admission blood glucose,C-reactive protein and peritoneal dialysis were independent risk factors for IFD in emergency critically ill patients.
聂玲玲;张莉
中国人民解放军空军军医大学第一附属医院急诊科,西安 710032中国人民解放军空军军医大学第一附属医院急诊科,西安 710032
临床医学
急诊危重症患者真菌感染真菌分布药敏分析易感因素
emergencycritically ill patientsfungal infectionfungal distributiondrug sensitivity analysispredisposing factor
《中国真菌学杂志》 2024 (5)
451-457,7
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