念珠菌血症患者病原菌分型及干预成效

Typing of pathogens and intervention efficacy of candidemia in patients

摘要:

目的 了解某院念珠菌血症病原菌分布、耐药情况及标准化医院感染干预措施应用成效。 方法 选取淮安市某医院2015年1月—2019年12月住院患者为对照组, 2020年1月—2022年12月住院患者为干预组, 实施标准化医院感染干预措施。分析念珠菌血症患者的临床资料, 包括菌群分布、耐药情况及医院感染发病情况等。 结果 对照组共有507 974例住院患者, 干预组392 616例。8年内共有181例念珠菌血症患者, 其中76例为医院感染念珠菌血症。181株念珠菌中白念珠菌、光滑念珠菌、都柏林念珠菌、热带念珠菌及近平滑念珠菌分别占比38.12%、21.55%、14.92%、14.37%及9.39%。医院感染念珠菌菌群临床分布差异有统计学意义(P＜0.05)。热带念珠菌耐药性较高(P＜0.05)。对照组中念珠菌血症117例, 发病率为0.23‰, 医院感染58例, 医院感染发病率为0.11‰; 干预组中念珠菌血症64例, 发病率为0.11‰, 医院感染18例, 医院感染发病率为0.05‰; 两组患者念珠菌血症发病率、医院感染发病率比较, 差异均有统计学意义(均P＜0.05)。念珠菌血症病死率为6.08%, 医院感染念珠菌血症病死率为7.89%。 结论 医院感染念珠菌血症临床分布散在, 菌株耐药情况无特异性, 实施标准化医院感染干预措施助力临床减少念珠菌血症医院感染。

Abstract:

Objective To investigate the distribution and antimicrobial resistance of pathogens of candidemia in a hospital, and explore the application efficacy of standardized intervention measures for healthcare-associated infection (HAI). Methods Patients who were hospitalized in a hospital in Huai'an City from January 2015 to December 2019 were select as the control group, and those from January 2020 to December 2022 were as the intervention group. Standardized HAI intervention measures were implemented. Clinical data of patients with candidemia were analyzed, including bacterial distribution, antimicrobial resistance, and HAI incidence. Results There were a total of 507 974 hospitalized patients in the control group and 392 616 in the intervention group. Over eight years, there were 181 cases of candidemia, 76 of which were HAI-associated candidemia. Among the 181 Candida strains, the proportions of Candida albicans, Candida glabrata, Candida dubliniensis, Candida tropicalis and Candida parapsilosis were 38.12%, 21.55%, 14.92%, 14.37% and 9.39%, respectively. Difference in the clinical distribution of HAI-associated Candida was statistically significant (P < 0.05). Candida tropicalis had high antimicrobial resistance (P < 0.05). In the control group, there were 117 cases of candidemia, with an incidence of 0.23 ‰; and 58 HAI cases, with a HAI incidence of 0.11 ‰. In the intervention group, there were 64 cases of candidemia, with an incidence of 0.11 ‰; and 18 HAI cases, with a HAI incidence of 0.05‰. The incidences of candidemia and HAI were both statistically significant between the two groups (both P < 0.05). The mortalities of candidemia and HAI-associated candidemia were 6.08% and 7.89%, respectively. Conclusion The clinical distribution of HAI-associated candidemia is sporadic, and antimicrobial resistance of strains is unspecific. The implementation of standardized HAI intervention measures can reduce HAI-associated candidemia.