重症烧伤患者血培养念珠菌阳性的病原学特征

doi:10.20223/j.cnki.1000-8535.2025.02.009

摘要/Abstract

摘要： 目的分析重症烧伤患者血培养标本中检测出念珠菌的临床分布,探究重症烧伤患者血流念珠菌感染的病原学特征。方法选取2012—2023年在广州市红十字会医院住院治疗的重症烧伤患者血培养标本1 148份,分析分离出念珠菌的非重复患者病死率、菌种分布、同时送检的其他类型标本念珠菌培养结果及患者念珠菌血流感染的检出时间与季节分布、抗菌药物使用情况及对常用抗真菌药物的耐药情况。结果 1 148份血培养标本中77份检出真菌,阳性率为6.71%。检出念珠菌感染的非重复患者27例,其中近平滑念珠菌13例,构成比为48.15%、白念珠菌8株,构成比为29.63%。血与静脉导管培养均检出念珠菌的有22例（81.48%）;血与伤口分泌物培养圴检出念珠菌的有10例（37.04%）;血、静脉导管、伤口分泌物培养圴检出念珠菌的有4例（14.81%）。静脉导管检出念珠菌高于其他类型标本。27例重症烧伤患者血流感染检出念珠菌的时间主要分布在入院后第2~3周、季节主要分布在春夏季。近平滑念珠菌、白念珠菌、热带念珠菌对氟康唑敏感率分别为83.33%、87.50%和75.00%。结论重症烧伤患者血流近平滑念珠菌检出率最高,发生血流感染时间主要在春夏季及烧伤入院后第2~3周,静脉导管留置是增加重症烧伤患者念珠菌血流感染的因素。我院念珠菌对抗真菌药物具有较高敏感性。

关键词: 重度烧伤, 念珠菌感染, 血培养, 静脉导管, 伤口分泌物

Abstract: Objective To retrospective analyze the clinical distribution of Candida species detected in blood cultures of patients with severe burns and to investigate the etiological characteristics of Candida bloodstream infections in these patients. Methods A total of 1 148 blood culture specimens were collected from patients with severe burns hospitalized at an institution between 2012 and 2023．Patients data with Candida bloodstream infections isolated from 1 148 blood culture specimens were analyzed,including mortality rates,species distribution,Candida culture results from other simultaneously collected specimen types,and the timing and seasonal distribution of Candida bloodstream infections,the use of antibiotics and resistance to commonly-used antifungal drugs. Results A total of 1 148 blood culture samples,77 fungi were separated,resulting in a positive rate of 6.71%．Among the 27 patients with Candida infections,13 cases（48.15%）were caused by Candida parapsilosis and 8 cases（29.63%）by Candida albicans．Candida was isolated from both blood and intravenous catheter cultures in 22 cases,with a positivity rate of 81.48%．Candida was isolated from both blood and wound secretion cultures in 10 cases（positivity rate of 37.04%）,and 4 cases from blood,intravenous catheter and wound secretion cultures（positivity rate of 14.81%）．The detection rate of Candida from intravenous catheters was higher than that from other specimen types．Candida bloodstream infections were most commonly observed during the 2nd and 3rd week after admission,with a seasonal peak in spring and summer．The susceptibility rates of Candida parapsilosis、Candida albicans and Candida tropicalis to fluconazole were 83.33%、87.50% and 75.00%,respectively. Conclusions The detection rate of Candida parapsilosis in bloodstream infections among patients with severe burns was the highest。These infections predominantly occur during the spring and summer and in the 2nd and 3rd week post-admission．The presence of intravenous catheters significantly contributes to Candida infections．The Candida in the hospital has high sensitivity to antifungal drugs．

Key words: severe burns, Candida infections, blood culture, intravenous catheters, wound secretion

赖艳榕, 沈仲华, 朱伟聪, 曹颖仪, 何雅军. 重症烧伤患者血培养念珠菌阳性的病原学特征[J]. 广州医药, 2025, 56(2): 197-202.

LAI Yanrong, SHEN Zhonghua, ZHU Weidong, CAO Yingyi, HE Yajun. Pathogenic characteristics of Candida positive blood culture in severe burn patients[J]. Guangzhou Medical Journal, 2025, 56(2): 197-202.

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