念珠菌血流感染患者临床特征及危险因素分析

Analysis of Clinical Characteristics and Risk Factors of Patients with Candidemia

摘要: 目的：探讨念珠菌血流感染的临床特征，危险因素，药敏结果，为念珠菌血流感染的预防以及合理使用抗真菌药物提供依据。方法：回顾性纳入某院2023年8月~2025年8月住院患者；以念珠菌血流感染者83例为病例组，对照组为同期血培养阴性83例(1:1)，收集患者临床资料与实验室指标，采用单因素分析及多因素Logistic回归筛选发生风险因素；在感染组内按院内结局分为死亡组38例与存活组45例，分析院内死亡相关因素。结果：分离菌株以白色念珠菌为主(45株，54.2%)，其次为热带念珠菌(26株，31.3%)和近平滑念珠菌(8株，9.6%)。热带念珠菌唑类耐药率较高(氟康唑59.1%、伊曲康唑77.3%、伏立康唑60.9%)。多因素分析显示，入院天数、肾功能不全及低白蛋白血症与念珠菌血流感染独立相关。感染者院内病死率为45.8%(38/83)；低白蛋白血症、入住ICU、深静脉置管及近30天手术史与院内死亡独立相关。结论：念珠菌血流感染受多种因素共同影响，应加强住院高危人群的早期识别与全流程管理，并结合药敏结果优化经验性及目标性抗真菌治疗，从而降低感染发生率和不良结局。

Abstract: Objective: To describe the clinical features, risk factors, and antifungal susceptibility patterns of Candidemia, and to provide evidence for prevention and rational antifungal use. Methods: A single-center retrospective case-control study was conducted from August 2023 to August 2025. Eighty-three patients with Candidemia were enrolled as the case group, and 83 contemporaneous patients with negative blood cultures were selected as controls (1:1). Clinical characteristics and laboratory parameters were collected, and univariate analyses and multivariable logistic regression were performed to identify risk factors for Candidemia. Within the Candidemia group, patients were further categorized into a non-survivor group (n = 38) and a survivor group (n = 45) according to in-hospital outcomes, and factors associated with in-hospital mortality were examined. Results: Candida albicans was the most common isolate (45/83, 54.2%), followed by Candida tropicalis (26/83, 31.3%) and Candida parapsilosis (8/83, 9.6%). C. tropicalis exhibited high resistance to azoles (fluconazole 59.1%, itraconazole 77.3%, and voriconazole 60.9%). Multivariable analysis identified longer time from admission to blood culture collection, renal insufficiency, and hypoalbuminemia as independent factors associated with Candidemia. The in-hospital mortality was 45.8% (38/83); hypoalbuminemia, ICU admission, central venous catheterization, and surgery within the preceding 30 days were independently associated with in-hospital death. Conclusion: Candidemia is influenced by multiple factors. Early identification and comprehensive management of high-risk hospitalized patients should be strengthened, and both empirical and targeted antifungal therapy should be optimized based on susceptibility results to reduce the incidence of infection and adverse outcomes.