目的 了解近年來呼吸科重癥加強(qiáng)治療病房(RICU)院內(nèi)肺部真菌感染的發(fā)病情況、相關(guān)因素、菌株分布及治療現(xiàn)狀。方法 對(duì)2000年7月~2005年6月長(zhǎng)海醫(yī)院RICU診斷的47例院內(nèi)肺部真菌感染患者的臨床資料進(jìn)行回顧性分析。結(jié)果 近五年RICU共診斷院內(nèi)肺部真菌感染47例,均為臨床診斷,其發(fā)病率顯著高于同時(shí)期普通病房的發(fā)病率(10.8%比1.8%,P lt;0.005)。慢性阻塞性肺疾?。–OPD)和細(xì)菌性肺炎是最常見的呼吸系統(tǒng)基礎(chǔ)疾病,分別占38.3%和36.2%;41例患者(87.2%)具有肺部真菌感染的危險(xiǎn)因素。與普通病房相比,RICU患者曲霉感染所占比例更高(14.3%),但二者無顯著差異(P gt;0.1);熱帶念珠菌及耐氟康唑的光滑念珠菌等的比例也較高,但克柔念珠菌較低??拐婢委煹挠行蕿?9.1%,氟康唑?yàn)樽畛S玫目拐婢幬?。與普通病房相比,RICU患者的死亡率升高(18.6%),但二者無顯著差異(P gt;0.1)。結(jié)論 RICU患者院內(nèi)肺部真菌感染的發(fā)病率明顯高于普通病房,其中曲霉和耐氟康唑的念珠菌感染所占比重較高。因RICU院內(nèi)肺部真菌感染患者預(yù)后相對(duì)較差,應(yīng)早期采用有效的干預(yù)措施。
引用本文: 武寧,黃怡,李強(qiáng),楊玉波,邵曉光,李海燕. 呼吸科重癥加強(qiáng)治療病房院內(nèi)肺部真菌感染47例臨床分析. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2008, 08(3): 182-186. doi: 復(fù)制
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- 1. Kam LW,Lin JD.Management of systemic candidal infections in the intensive care unit.Am J Health Syst Pharm,2002,59:33-41.
- 2. Vincent JL,Chierego M,Struelens M,et al.Infection control in the intensive care unit.Expert Rev Anti Infect Ther,2004,2:795-805.
- 3. 中華內(nèi)科雜志編輯委員會(huì).侵襲性肺部真菌感染的診斷標(biāo)準(zhǔn)與治療原則(草案).中華內(nèi)科雜志,2006,45:697-700.
- 4. 馬軍.侵襲性真菌感染的流行病學(xué).中華醫(yī)學(xué)雜志,2005,85:1443-1444.
- 5. 劉正印,盛瑞媛,李旭麗,等.院內(nèi)真菌感染149例分析.中華醫(yī)學(xué)雜志,2003,83:399-402.
- 6. Muquim A,Dial S,Menzies D.Invasive aspergillosis in patients with chronic obstructive pulmonary diseases.Can Respir J,2005,12:199-204.
- 7. Dimopoulos G,Piagnerelli M,Berre J,et al.Disseminated aspergillosis in intensive care unit patients:an autopsy study.J Chemother,2003,15:71-75.
- 8. José Garnacho-Montero,Rosario Amaya-Villar,Carlos Ortiz-Leyba,et al.Isolation of Aspergillus spp.from the respiratory tract in critically ill patients:risk factors,clinical presentation and outcome.Critical Care,2005,9:191-199.
- 9. Nina Singh,David L.Paterson.Aspergillus Infections in Transplant Recipients.Clin Microbiol Rev,2005,18:44-69.
- 10. Pierre Emmanuel Charles,F(xiàn)rdric Dalle,Herv Aube,et al.Candida spp.colonization significance in critically ill medical patients:a prospective study.Intensive Care Med,2005,31:393-400.
- 11. Richardson MD.Changing patterns and trends in systemic fungal infections.J Antimicrob Chemother,2005,56(Suppl1):5-11.
- 12. Khasawneh F,Mohamad T,Moughrabieh MK,et al.Isolation of Aspergillus in critically ill patients:a potential marker of poor outcome.J Crit Care,2006,21:322-327.
- 13. Wisplinghoff H,Bischoff T,Tallent SM,et al.Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study.Clin Infect Dis,2004,39:309-317.
- 14. Kontoyiannis DP,Bodey GP.Invasive aspergillosis in 2002:an update.Eur J Clin Microbiol Infect Dis,2002,21:161-172.
- 15. Vandewoude KH,Vogelaers D,Blot SI.Aspergillosis in the ICU - The new 21st century problem? Med Mycol,2006,44 Suppl:71-76.
- 16. 繆競(jìng)智.老年人肺部真菌感染的診斷與治療.中華老年醫(yī)學(xué)雜志,2005,24:329-331.
- 17. Piarroux R,Grenouillet F,Balvay P,et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med,2004,32:2443-2449.
- 18. Ostrosky-Zeichner L.Novel approaches to antifungal prophylaxis.Expert Opin Investig Drugs,2004,13:665-672.
- 19. Ibanez-Nolla J,Nolla-Salas M,Leon MA,et al.Early diagnosis of candidiasis in non-neutropenic critically ill patients.J Infect,2004,48:181-92.