| Objective:To investigate the antifungal susceptibility,clinical features,risk factors,and prognosis of people with Candida albicans and non Candida albicans in our hospital during the five years,find out the differences and provide guidance for the clinical antifungal treatments.Methods The clinical data of candidemiasfrom 2012-01-01 to 2017-09-01 in Shengjing Hospital were collected.The clinical characteristics,risk factors,drug sensitivity and prognostic factors of Candida albicans and non-Candida albicans were compared and analyzed.I used the SPSS19.0,the t-test to analyze the measurement data that conformed to the normal distribution,and used the Mann-Whitney U test for the measurement data that did not conform to the normal distribution.c~2test were used in numeration data.Factors with P less than 0.1 were included in the logistic multivariate regression analysis model.P less than 0.05 was statistically significant.Results:During the study period,adult patients with candidemia in the hospital were 180cases,including 64 cases of Candida albicans(35.6%),29 cases of Candida glabrata(17.1%),and 69 cases(38.3%)of Candida parapsilosis.There were 18 cases(10%)of Candida tropicalis,2 cases(1.15%)of Candida krusei,and 2 cases(1.15%)of Candida albicans.The mean age of the patients was 61.84±15.93 years old,the average age of patients with Candida albicans infection was 64.16±16.45,and the average age of patients with non-Candida albicans was 61.56±15.06.There were 123 male patients(68.3%),57 female patients(31.7%).In this survey,42 persons(23.3%)were medical patients and 138 persons were surgical patients(76.7%).The total number of death was46,42(23.3%)of them died within 30 days,and 134(74.4%)were alive.Among the death patients,there were 23 cases(54.8%)of Candida albicans,6 cases(14.3%)of Candida glabrata,10 cases(23.8%)of Candida parapsilosis,and 7 cases(16.7%)of Candida tropicalis.Fever was the main clinical symptom,172 patients with body temperature above38?,including 64 cases of Candida albicans(35.6%),108 cases of non-Candida albicans(62.8%),In the non-Candida albicans,there were 25 cases of Candida glabrata(13.8%),69 cases(38.3%)of Candida parapsilosis,18 cases(10%)of Candida tropicalis,2 cases(1.15%)of Candida krusei,2 cases of Candida albicans(1.15%).There was no significant difference in the number of patients with candida albicans fever and non candida albicans(P=0.052).The 64 strains of candida albicans were sensitive to most part of antifungal drugs.Candida albicans was all sensitive to flucytosine and voriconazole,and 2(3.1%)Candida albicans were not sensitive to itraconazole.2 cases(3.1%)of Candida albicans were not sensitive to fluconazole.116 strains of non-Candida albicans,1 case of Candida krusei(0.086%)was insensitive to flucytosine,24 cases(20.6%)of non-Candida albicans were not sensitive to itraconazole,of which 14 cases(58.3%)were Candida glabrata,8cases(33.3%)were Candida tropicalis,and 2 cases(8.3%)were Candida krusei;8 cases(6.9%)of non-Candida albicans are not sensitive to voriconazole,3 cases(37.5%)of them were Candida glabrata,4 cases(50%)were Candida tropicalis,1 case(12.5%)was Candida krusei;12 cases(10.3%)of non-Candida albicans were not sensitive to fluconazole,7 cases(58.3%)of them were Candida glabrata,3 cases(25%)were Candida tropicalis,and 2 cases(16.7%)were Candida krusei.In terms of risk factors for infection and prognosis,parenteral nutrition(78.1%vs87.9%,P=0.043,OR=0.414)was an independent risk factor for non-candidemia albicans.Catheterization(73.4%vs 57.6%,P=0.029,OR=2.188)was the independent risk factors of candidemia.Low protein(32.75±5.23g vs 27.37±4.93g,P=0.030,OR=1.191)and admission to ICU(P=0.027,OR=0.139)were risk factors for poor prognosis of Candida albicans.In the ICU(P=0.004,OR=0.092),low platelets(220.44±113.05 vs 125.42±94.34,P=0.094,OR:1.1.006),and surgery(P=0.006,OR=7.697)were the risk factors led to the poor prognosis of non-albicans candidemiaCoclusion:1.1n the past 6 years,the number of non-albicans candidemia in our hospital was more than that of Candida albicans.It was mainly caused by Candida parapsilosis.The resistance rate of non-Candida albicans to azoles was higher.It was more common with Candida glabrata and Candida tropicalis.2.Indwelling catheterization is an independent risk factor for Candida albicans infection,and parenteral nutrition is an independent risk factor for non-albicans candidemia.3.The prognosis of patients with candida albicans is worse than that of patients with non-albicans candidemia.The independent risk factors for the poor prognosis of candida albicemia are ICU.Low protein,drainage and indwelling gastric tube are protective factors.Non-albicans candidemia into the ICU and low platelets are independent risk factors of poor prognosis,and reasonable surgery is helpful improve patient outcomes. |
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