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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。
Objective To understand the clinical features of children with invasive candidiasis and to explore the risk factors of Candida infection in bloodstream. Methods 134 cases of invasive candidiasis diagnosed or clinically diagnosed in 5 tertiary hospitals in Urumqi from January 2010 to December 2015 were selected as the study subjects. The multicenter and retrospective study was conducted to detect the type and the constituent ratio of fungal infection in children and to compare the clinical data of children with Candida infection and non-bloodstream infection. Logistic regression was used to investigate the prevalence of Candida Risk factors for infection. Results A total of 134 strains of Candida were isolated from 134 children, of which Candida albicans accounted for 53.0%. The incidence of invasive candidiasis in PICU and non-PICU wards were 41.8% and 48.5%, respectively. Bloodstream infections were predominant (68 cases, 50.7%), followed by urinary tract infections (45 cases, 33.6%). Candida bloodstream infection group and non-blood flu group in age and broad-spectrum antibiotic use, the incidence of chronic renal insufficiency, the incidence of heart failure, indwelling catheter rate and non-Candida albicans infection rate difference was statistically significant Significance (P <0.05). Multivariate logistic regression analysis showed that age (1-24 months) (OR = 6.027), non-Candida albicans infection (OR = 1.020) was an independent risk factor for Candida infection. Conclusions The prevalence of invasive candidiasis is basically the same in pediatric ICU and non-ICU wards. Infectious strains are mainly non-Candida albicans. Bloodstream infection is the most common form of Candida infection. Ages 1- 24 months and non-white Candida infection in children with increased risk of Candida bloodstream infection.