中国真菌学杂志

目的 探讨ICU院内真菌性尿路感染临床特点和危险因素。方法 回顾性分析复旦大学附属上海市第五人民医院2016年1月至2020年12月期间ICU院内真菌性尿路感染患者临床资料，描述其临床特点、危险因素。结果 (1)2016年—2020年收入复旦大学附属上海市第五人民医院重症监护室患者共2 557例，符合研究条件的共130例，真菌性尿路感染发生率为5.1%。(2)ICU院内真菌性尿路感染临床表现不典型，其发生与性别、年龄、导尿管留置时间有关，与年份无关。(3)尿病原体培养以白念珠菌为主(42.5%),其次为光滑念珠菌(31.3%),热带念珠菌(19.4%),近平滑念珠菌(4.5%),其他念珠菌(2.2%)。(4)对ICU院内真菌性尿路感染危险因素分析，单因素分析发现糖尿病、原发疾病脑卒中、抗生素种类、感染前血白细胞计数，感染前灌肠5个因素具有统计学意义(P<0.05)。将单因素分析有意义的指标纳入多因素分析中，结果提示糖尿病(P<0.001,OR=5.488)、原发疾病脑卒中(P=0.009,OR=2.782)、感染前血白细胞计数(P=0.014,OR=3.515)、感染前灌肠(P=0.001,OR=3.567)是ICU院内真菌性尿路感染发生的独立危险因素。结论 针对ICU院内真菌性尿路感染，我们应采取积极措施治疗原发疾病及基础疾病，同时应警惕灌肠后所致的肠源性污染。

Objective To investigate the clinical characteristics and risk factors of nosocomial fungal urinary tract infection in ICU. Methods The clinical data of patients with fungal urinary tract infection in the ICU of Shanghai Fifth People's Hospital affiliated to Fudan University from January 2016 to December 2020 were retrospectively analyzed, and the clinical characteristics and risk factors of the patients were described. Results(1)From 2016 to 2020, a total of 2557 patients were enrolled in the intensive care unit of Shanghai Fifth People's Hospital Affiliated to Fudan University, and 130 patients met the research conditions. The incidence of fungal urinary tract infection was 5.1%.(2)The clinical manifestations of nosocomial fungal urinary tract infection in ICU were atypical, and its occurrence was related to gender, age, and catheter indwelling time, but not to the year.(3)In the urine culture, Candida albicans was the main pathogen, accounting for 42.5%, followed by Candida glabra(31.3%), Candida tropicalis(19.4), Candida parapsilosis(4.5%), and other Candida(2.2%).(4)The risk factors of nosocomial fungal urinary tract infection in ICU were analyzed. Univariate analysis showed that diabetes, primary disease stroke, antibiotics, preinfection white blood cell count and preinfection enema had statistical significance(P<0.05).The significant indicators from univariate analysis were incorporated into the multivariate analysis. The results showed that diabetes mellitus(P<0.001,OR=5.488), primary disease stroke(P=0.009,OR=2.782), preinfection white blood cell count(P=0.014,OR=3.515) and preinfection enema(P=0.001,OR=3.567) were independent risk factors for nosocomial fungal urinary tract infection in ICU. Conclusion For the nosocomial fungal urinary tract infection in ICU, we should take active measures to treat the primary disease and the basic disease, and at the same time, we should be alert to the enterogenous pollution caused by enema.