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医院艾滋病住院患者合并真菌感染的菌种分布及影响因素
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1.郑州市第六人民医院 河南省传染病医院检验科, 河南 郑州 450015;2.郑州市第六人民医院 河南省传染病医院感染防控科, 河南 郑州 450015;3.郑州市第六人民医院 河南省传染病医院感染科, 河南 郑州 450015

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陈媛媛 E-mail: cyy1805@126.com

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基金项目:

国家"十三五"重大科技专项（2017ZX10202101-001-010）；郑州市科技攻关计划项目（141PPTGG318）


Species distribution and influencing factors of fungal infection among hospitalized patients with acquired immunodeficiency syndrome
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Affiliation:

1.Department of Laboratory Medicine, The Sixth People's Hospital of Zhengzhou, Henan Infectious Disease Hospital, Zhengzhou 450015, China;2.Department of Healthcare-associated Infection Prevention and Control, The Sixth People's Hospital of Zhengzhou, Henan Infectious Disease Hospital, Zhengzhou 450015, China;3.Department of Infectious Diseases, The Sixth People's Hospital of Zhengzhou, Henan Infectious Disease Hospital, Zhengzhou 450015, China

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    摘要:

    目的 了解传染病医院艾滋病住院患者合并真菌感染情况、菌种分布及其影响因素。 方法 选取2018年1月—2019年9月首次在某院住院治疗的艾滋病患者为研究对象，通过培养确定是否存在真菌感染。采用logistic回归分析确定艾滋病住院患者合并真菌感染的影响因素。 结果 2018年1月—2019年9月共有667例艾滋病住院患者，其中有195例发生真菌感染，感染率为29.24%。感染菌种以白念珠菌（163株）、新生隐球菌（36株）和马尔尼菲篮状菌（22株）为主。标本来源以口腔拭子（黏膜白斑，133株）、痰（41株）和血（31株）为主，其中，口腔拭子、痰检出真菌均以白念珠菌为主，分别为119、18株；血检出以马尔尼菲篮状菌（15株）为主。抗菌药物联合使用（OR=2.237，95%CI：1.190~4.204）、合并其他感染性疾病（OR=1.614，95%CI：1.013~2.574）和HIV-1 RNA载量高（OR=1.817，95%CI：1.039~3.176）是艾滋病住院患者合并真菌感染的独立危险因素（均P < 0.05）；系统抗病毒治疗（OR=0.736，95%CI：0.576~0.940）、CD4+T细胞水平高（OR=0.583，95%CI：0.351~0.968）和淋巴细胞计数高（OR=0.798，95%CI：0.644~0.988）是艾滋病住院患者合并真菌感染的独立保护因素（均P < 0.05）。 结论 艾滋病住院患者合并真菌感染的发生率较高。早期应对患者进行系统检查和规范抗病毒治疗；提高机体血清蛋白水平，改善营养状况；减少侵入性诊疗操作；合理选择抗菌药物并规范抗菌药物联用的种类和剂量等措施，可减少艾滋病住院患者合并真菌感染的发生。

    Abstract:

    Objective To understand the occurrence, pathogen distribution, and influencing factors for fungal infection in hospitalized patients with acquired immunodeficiency syndrome (AIDS) in an infectious diseases hospital. Methods AIDS patients who were hospitalized in a hospital for the first time from January 2018 to September 2019 were selected as the research objects, fungal infection was determined through culture. Logistic regression analysis was used to determine the influencing factors for fungal infection in hospitalized AIDS patients. Results There were 667 hospitalized AIDS patients from January 2018 to September 2019, 195 (29.24%) of whom had fungal infection. The main infection strains were Candida albicans (163 strains), Cryptococcus neoformans (36 strains) and Talaromyces marneffei (22 strains). The main sources of specimens were oral swabs (leukoplakia, 133 strains), sputum (41 strains) and blood (31 strains), oral swabs and sputum mainly isolated Candida albicans (119, 18 strains respectively); blood specimens mainly isolated Talaromyces marneffei (15 strains). Combined use of antimicrobial agents (OR=2.237, 95% CI: 1.190-4.204), combined with other infectious diseases (OR=1.614, 95% CI: 1.013-2.574) and high HIV-1 RNA load (OR=1.817, 95% CI: 1.039-3.176) were independent risk factors for fungal infection in hospitalized AIDS patients (all P < 0.05); systemic antiviral therapy (OR=0.736, 95% CI: 0.576-0.940), high CD4+ T cell level (OR=0.583, 95% CI: 0.351-0.968) and high lymphocyte count (OR=0.798, 95% CI: 0.644-0.988) were independent protective factors for fungal infection in hospitalized AIDS xpatients (all P < 0.05). Conclusion Incidence of fungal infection in hospitalized AIDS patients is high, which can be reduced through conducting systematic examination and standardizing antiviral treatment early, improving blood protein level and nutritional status, reducing invasive diagnosis and treatment procedure, rationally selecting antimicrobial agents and standardizing types and dosage of antimicrobial agents.

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班立芳,赵鲜丽,孔庆飞,等.医院艾滋病住院患者合并真菌感染的菌种分布及影响因素[J]. 中国感染控制杂志,2021,(5):397-402. DOI:10.12138/j. issn.1671-9638.20217852.
Li-fang BAN, Xian-li ZHAO, Qing-fei KONG, et al. Species distribution and influencing factors of fungal infection among hospitalized patients with acquired immunodeficiency syndrome[J]. Chin J Infect Control, 2021,(5):397-402. DOI:10.12138/j. issn.1671-9638.20217852.

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  • 收稿日期:2020-07-29
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  • 在线发布日期: 2021-07-26
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