中文摘要：

目的了解非重症监护病房（ICU）假丝酵母菌血症患者的临床特点、菌种分布及预后危险因素。方法回顾性调查2011年1月1日至2014年1月31日浙江大学医学院附属第一医院普通病房发生的72例血培养假丝酵母菌阳性患者的资料，分析其临床特征、菌种分布、治疗、预后等，并采用，检验、Fisher确切概率法和多元Logistic回归分析筛选感染和预后的危险因素。结果72例患者中，白假丝酵母菌血症29例（40．28％），非白假丝酵母菌血症43例（59．72％）。单因素分析显示：老年（χ^2=6．109，P〈0．05）、男性（χ^2=5．258，P〈0．05）、实体器官肿瘤（χ^2=7．186，P〈0．01）、接受胃肠外营养（χ^2=6．512，P〈0．05）、血培养前30d内接受手术（χ^2=4．284，P〈0．05）、留置胃管（χ^2=4．164，P〈0．05）、留置导尿管（χ^2=3．952，P〈0．05）患者易患白假丝酵母菌血症；而血液系统肿瘤（P〈0．01）和中性粒细胞缺乏者（P〈0．05）易患非白假丝酵母菌血症。72例患者中血培养阳性后28d内死亡14例，总病死率为19．44％。预后多因素回归分析显示，感染性休克（OR：84．818，95％可信区间：3．560～2020．567，P〈0．01）、急性生理与慢性健康状况（APACHEⅡ）评分（OR：1．252，95％可信区间：1．035～1．515，P〈0．05）是患者死亡的独立危险因素，而拔除或更换中心静脉置管（OR：0．002，95％可信区间：0．000～0．135，P〈0．01）是患者死亡的保护因素。结论非ICU病区假丝酵母菌血症的病原菌以非白假丝酵母菌居多，APACHEII评分高、合并感染性休克提示预后不良，而拔除或更换中心静脉置管可改善患者的预后。

英文摘要：

Objective To investigate clinical features, pathogen distribution and prognostic risk factors of candidemia in patients from non-intensive care unit （ICU） wards. Methods Seventy two patients with blood culture-confirmed candidemia were admitted in non-ICU wards in the First Affiliated Hospital of Zhejiang University during January 1 st 2011 and January 31th 2014. The clinical data of patients, including clinical features, pathogen distribution, treatment and prognosis were retrospectively analyzed. The risk factors for the infection and the fatality of patients were assessed by chi-square test, Fisher exact probability test and muhivariate Logistic regression analysis. Results Among 72 patients with candidemia, 29 （40. 28% ） were related to Candida albicans and 43 （ 59. 72% ） were related to non-Candida albicans. Univariate analysis showed that elderly people （χ^2 = 6. 109, P 〈 0.05 ）, male （χ^2 = 5. 258, P 〈 0.05 ）, solid tumor （χ^2= 7. 186, P 〈 0.01 ）, parenteral nutrition （χ^2 = 6. 512, P 〈 0.05 ）, surgery within 30 d （χ^2 = 4. 284, P 〈 0.05 ）, indwelling gastric tube （X2 = 4. 164, P 〈 0.05 ）, and indwelling urethral catheter （χ^2 = 3.952, P 〈 O. 05 ） were risk factors of Candida albicans-related candidemia; while patients with hematologic malignancies （P 〈 O. 01 ） and neutropenia （P 〈 0.05 ） were prone to non-Candida albicans- related candidemia. Fourteen cases died within 28 days from the diagnosis of candidemia with an overall 28-d fatality rate of 19.44%. Multivariate Logistic regression analysis indicated that septic shock（ OR： 84. 818, 95% confidential interval： 3. 560-2020. 567, P 〈 0. 01 ）and acute physiology and chronic health evaluation U（APACHE 11 ） score （OR： 1. 252, 95% confidential interval： 1.035-1. 515, P 〈 O. 05） were independent risk factors of death, while removal or replacement of central venous catheter （ OR： O. 002, 95% confidential interval： 0-0. 135, P 〈 0.01 ） was a protective fact