目的 本研究旨在探讨白念珠菌和非白念珠菌血症的流行病学、危险因素和预后。方法 回顾分析南京医科大学第一附属医院2016年1月-2020年12月171例念珠菌血症患者临床资料。通过卡方检验和二元Logistic回归分析对白念组和非白念组血流感染患者的临床危险因素进行比较，确定与念珠菌感染有关的危险因素，且进一步分析与念珠菌血症预后相关的独立危险因素。结果 光滑念珠菌是念珠菌血症患者中最常见的分离菌（28.65%），其次为白念珠菌（28.07%）、热带念珠菌（21.64%）、近平滑念珠菌（18.13%）和其他念珠菌（3.51%），非白念珠菌占71.93%（123/171）。多因素分析显示机械通气（OR 2.588; 95%CI:1.119-5.987; P=0.026）是白念珠菌血症的独立危险因素。所有念珠菌对两性霉素B均敏感，白念珠菌、光滑念珠菌和近平滑念珠菌对氟康唑的敏感率分别为91.8%、91.7%和90.3%，热带念珠菌的耐药性相对较高。171例念珠菌血症患者中，有48例死亡，病死率为28.07%。多因素分析显示年龄（OR 1.027; 95%CI:1.004-1.050; P=0.022）、深静脉置管（OR 2.489; 95%CI:1.033-5.996; P=0.042）和入住ICU（OR 2.921; 95%CI:1.020-8.362; P=0.046）是与死亡率相关的独立危险因素。结论 我院念珠菌血症的念珠菌分布与其他医院存在差异。除热带念珠菌外，绝大多数念珠菌对抗真菌药物敏感性较高，为经验抗真菌药物的选择提供有用的信息。
Objective This study aimed to investigate the epidemiology, risk factors and prognosis of candidemia caused by Candida albicans and non-albicans. Methods The clinical data of 171 patients with Candidemia in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were retrospectively analyzed. Chi square test and multivariate logistic regression analysis were used to compare the risk factors of patients with bloodstream infection in Candida albicans and non-albicans group, to identify the risk factors related to Candida infection, and to further analyze the independent risk factors related to the prognosis of Candidemia. Results Candida glabrata (28.65%) was the most common isolate in candidemia patients, followed by Candida albicans (28.07%), Candida tropicalis (21.64%), Candida parapsilosis (18.13%) and other Candida (3.51%), Candida non-albicans accounted for 71.93% (123/171). Multivariate analysis showed that mechanical ventilation (OR 2.588; 95% CI: 1.119-5.987; P=0.026) was an independent risk factor for Candida albicans bloodstream infection. All Candida strains were sensitive to amphotericin B. The susceptibility rates of Candida albicans, Candida glabrata and Candida parapsilosis to fluconazole were 91.8%, 91.7% and 90.3% respectively. The drug resistance of Candida tropicalis was relatively high. 48 patients died among 171 patients with Candidemia, with a mortality rate of 28.07%. Multivariate analysis showed that age (OR 1.027; 95%CI:1.004-1.050; P=0.022), deep vein catheterization (OR 2.489; 95%CI:1.033-5.996; P=0.042) and ICU admission (OR 2.921; 95%CI:1.020-8.362; P=0.046) was an independent risk factor associated with mortality. Conclusion The distribution of Candida in our hospital is different from that in other hospitals. Most of Candida are highly sensitive to antifungal drugs, but the drug resistance rate of Candida tropicalis is relatively high. It may provide useful information for the preliminary experience of antifungal drug selection.