乌鲁木齐市多中心儿童侵袭性念珠菌病临床特征及其血流感染的危险因素分析

Clinical features of invasive candidiasis and risk factors for Candida bloodstream infection in children: a multicenter study in Urumqi, China

摘要:

目的 了解儿童侵袭性念珠菌病的临床特征，探讨念珠菌血流感染的危险因素。方法 选取2010年1月至2015年12月乌鲁木齐市5家三级医院确诊或临床诊断的134例侵袭性念珠菌病患儿为研究对象。采用多中心、回顾性研究方法，检测患儿真菌感染类型及构成比，比较念珠菌血流感染组及非血流感染组患儿的临床资料，并应用logistic多因素回归分析探讨念珠菌血流感染的危险因素。结果 134例患儿中分离出134株念珠菌菌株，其中非白色念珠菌占53.0%。侵袭性念珠菌病在PICU及非PICU病区的发生率分别为41.8%、48.5%。血流感染为主（68例，50.7%），其次为尿路感染（45例，33.6%）。念珠菌血流感染组与非血流感组在年龄及广谱抗生素使用率、慢性肾功能不全发生率、心力衰竭发生率、留置尿管率及非白色念珠菌感染率比较中差异有统计学意义（P < 0.05）。多因素logistic回归分析显示，年龄（1~24个月）（OR=6.027）、非白色念珠菌感染（OR=1.020）是念珠菌血流感染的独立危险因素。结论 侵袭性念珠菌病在儿科ICU及非ICU病区发生率基本相同；感染菌株以非白色念珠菌为主；血流感染为最常见的念珠菌感染形式；年龄1~24个月及非白色念珠菌感染患儿发生念珠菌血流感染的风险增加。

Abstract:

Objective To investigate the clinical features of invasive candidiasis in children and the risk factors for Candida bloodstream infection. Methods A retrospective study was performed on 134 children with invasive candidiasis and hospitalized in 5 tertiary hospitals in Urumqi, China, between January 2010 and December 2015. The Candida species distribution was investigated. The clinical data were compared between the patients with and without Candida bloodstream infection. The risk factors for Candida bloodstream infection were investigated using multivariate logistic regression analysis. Results A total of 134 Candida strains were isolated from 134 children with invasive candidiasis, and non-albicans Candida (NAC) accounted for 53.0%. The incidence of invasive candidiasis in the PICU and other pediatric wards were 41.8% and 48.5% respectively. Sixty-eight patients (50.7%) had Candida bloodstream infection, and 45 patients (33.6%) had Candida urinary tract infection. There were significant differences in age, rate of use of broad-spectrum antibiotics, and incidence rates of chronic renal insufficiency, heart failure, urinary catheterization, and NAC infection between the patients with and without Candida bloodstream infection (P < 0.05). The multivariate logistic regression analysis showed that younger age (1-24 months) (OR=6.027) and NAC infection (OR=1.020) were the independent risk factors for Candida bloodstream infection. Conclusions The incidence of invasive candidiasis is similar between the PICU and other pediatric wards. NAC is the most common species of invasive candidiasis. Candida bloodstream infection is the most common invasive infection. Younger age (1-24 months) and NAC infection are the risk factors for Candida bloodstream infection.