摘要
目的探讨2019年-2023年南充地区五所医院临床分离念珠菌的流行病学特征、耐药性现状及危险因素,为侵袭性念珠菌感染的临床诊疗和耐药防控提供参考依据。方法采用回顾性研究方法,收集川北医学院附属医院等五所医院临床分离的2787株念珠菌感染患者数据,运用Whonet 5.6和SPSS 27.0软件进行统计分析,包括菌株种类分布、患者性别、年龄、科室、样本类型以及抗真菌药物耐药性,并采用Logistic回归分析感染危险因素。结果研究期间分离的念珠菌以白念珠菌占比最高(38.46%);老年人(≥60岁)感染率显著高于小于60岁人群(54.40%vs 45.60%,χ^(2)=21.54,P<0.05),但性别无明显差异;无菌部位标本中血液、腹水及胸水检出率居前三位,非无菌部位标本以尿液、脓液和泌尿生殖道拭子为主;科室分布以重症医学科(13.21%)、泌尿外科(11.52%)和整容烧伤外科(11.05%)为主。多因素分析广谱抗生素使用(OR=9.70)、侵入性操作(OR=68.53)、插管(OR=13.67)及放化疗(OR=100.31)是侵袭性感染的危险因素(均P<0.05)。药敏试验显示热带念珠菌对伏立康唑(21.71%),氟康唑(24.78%),两性霉素B(0.44%),伊曲康唑(20.61%)耐药率均高于其他念珠菌。结论南充地区念珠菌感染存在明显的年龄、部位及科室分布特征,热带念珠菌呈现多重耐药趋势,临床应加强真菌耐药监测并优化抗真菌药物使用策略,同时对具有危险因素患者应采取针对性防范措施。
Objective To investigate the epidemiological characteristics,resistance status and risk factors of Candida species isolated from five hospitals in Nanchong region from 2019 to 2023,providing a reference for the clinical diagnosis,treatment,and resistance prevention of invasive Candida infections.Methods A retrospective study was conducted,collecting data on 2,787 strains of clinically isolated Candida from five hospitals,including the Affiliated Hospital of North Sichuan Medical College and so on.Statistical analysis was performed using Whonet 5.6 and SPSS 27.0 software,including species distribution,patient age,gender,department,sample type,and antifungal drug resistance.Logistic regression was used to analyze risk factors for infection.Results During the study period,Candida albicans was the most prevalent species(38.46%).Elderly patients(≥60 years)had a significantly higher infection rate than younger groups(<60 years)(54.40%vs.45.60%,χ^(2)=21.54,P<0.05).But there was no significant difference in gender.Sterile-site specimens accounted for 10.44%,with blood,ascites,and pleural fluid being the most common,while non-sterile sites were primarily urine,pus,and urogenital swabs.The highest departmental distributions were in the Intensive Care Unit(13.21%),Urology Department(11.52%),and Plastic&Burn Surgery Department(11.05%).Multivariate analysis identified broad-spectrum antibiotic use(OR=9.70),invasive procedures(OR=68.53),catheterization(OR=13.67),and chemotherapy(OR=100.31)as independent risk factors for invasive infections(P<0.05).Antifungal susceptibility testing showed that Candida tropicalis exhibited higher resistance rates to voriconazole(21.71%),fluconazole(24.78%),amphotericin B(0.44%),and itraconazole(20.61%)compared to other Candida species.Conclusion There are obvious age,location,and departmental distribution characteristics of Candida infections in Nanchong.C.tropicalis showed a trend of multidrug resistance.Clinical monitoring of fungal resistance should be strengthened,and strategies for using antifungal drugs should be optimized.At the same time,targeted preventive measures should be taken for patients with risk factors.
作者
杨双双
钟宇琪
李红彦
张会
何建华
胥静
张红
郭斌
谢宁
YANG Shuangshuang;ZHONG Yuqi;LI Hongyan;ZHANG Hui;HE Jianhua;XU Jing;ZHANG Hong;GUO Bin;XIE Ning(Department of Clinical Laboratory,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China;School of Laboratory Medicine,North Sichuan Medical College,Nanchong 637000,Sichuan,China;Translational Medicine Research Center,North Sichuan Medical College,Nanchong 637000,Sichuan,China;Beijing Anzhen Nanchong Hospital of Capital Medical University,Nanchong Central Hospital,Nanchong 637000,Sichuan,China;Nanchong Traditional Chinese Medicine Hospital,Nanchong 637000,Sichuan,China;Gaoping District People's Hospital,Nanchong 637000,Sichuan,China;Xichong People's Hospital,Nanchong 637000,Sichuan,China)
出处
《西部医学》
2026年第1期76-81,共6页
Medical Journal of West China
基金
国家自然科学基金面上项目(82272436)。
关键词
侵袭性念珠菌病
耐药率
危险因素
菌种分布
流行病
Invasive candidiasis
Drug resistance analysis
Risk factors
Distribution characteristics
Epidemic disease
