普外科真菌感染84例临床调查

Clinical survey of 84 patients with fungal infections in General Surgery Depart- ment

目的:探讨普外科真菌感染的现状及临床特性,为外科手术后真菌感染的防治提供参考依据。方法:回顾性调查2002年1月-2003年12月本院普外科疑似真菌感染患者的临床概况,对其中经真菌涂片、培养阳性,并伴有临床症状、体征诊断为真菌感染患者的感染类型、危险因素和病原菌分布作进一步分析。结果:①我科2年中共有242株真菌培养阳性的临床标本,其中确诊或疑诊为真菌感染者84例。感染部位以消化道最常见。病原菌以白念念珠菌最常见,占58.2％,其次为光滑念珠菌、热带念珠菌和克柔念珠菌。②外科手术、长时间用抗菌药、恶性肿瘤、胃肠外营养是最常见的危险因素,50％以上的患者存在上述情况。③与感染有关的手术类型最多见的是胰十二指肠切除术,各病种中亦以胰腺肿瘤及炎症最多。④除抗厌氧菌药物外,第三代头孢菌素、亚胺培南、去甲万古霉素是曾有真菌感染的患者最常使用的抗生素。结论:①白念念珠菌仍为外科真菌感染的主要致病菌,而非白念念珠菌感染呈上升趋势。②我院普外科真菌感染以消化道感染为主。③尽量减少手术创伤、合理使用抗生素、尽早使用肠内营养、规范各类导管操作和护理等均是真菌感染的重要预防措施。

Objective: To investigate the prevalence of fungal infections in General Surgery Department in order to prevent and treat fungal infections more efficiently in postoperative patients. Methods:Clinical data from patients with suspected fungal infections in our department from January 2002 to December 2003 were collected and analyzed retrospectively. Types of infection, risk factors and pathogens were analyzed for fungal infection patients whose diagnosis were based on clinical symptoms, signs, fungal smear and fungal culture. Results; 242 strains of fungi were isolated from 84 patients with confirmed or suspected diagnosis of fungal infections. The most frequently isolated fungi were Candida albicans accounted for 58. 2% , followed by Candida glabrata, Candida tropicalis and Candida krusei. Gastrointestinal infection was the most common fungal infection. More than half of these patients had risk factors,such as major operations, malignant tumor, parenteral nutrition or prolonged use of antibiotics. Pancreas diseases and pancraticoduodenectomy were the most common underlying diseases and operation, respectively, and most patients have been treated with third-generation cephalosporins, imipenem and demethylvancomycin. Conclusions: Candida albicans is the major cause of fungal infection in surgical patients; the incidence of non-candida spp. have been increasing. Gastrointestinal tract is the most common site of fungal infections after general surgery. Minimizing trauma caused by operation, appropriate use of antibiotics, early start of enteral nutrition and standardize the procedure of inserting catheters are important for the prevention of fungal infections.