真菌败血症17例回顾性临床分析

Fungemia:A Retrospective Clinical Analysis of 17 Patients

目的 分析真菌败血症可能的一些相关因素，进一步探讨真菌败血症的防治措施。方法 对1995-2004年间医院诊断的真菌败血症17例进行回顾性临床分析。结果真菌败血症占10年间医院所有诊断败血症的5。52％；17例患者中主要菌种为热带念珠菌和白色念珠菌，有6例患者局部病灶真菌培养阳性；气管切开机械通气（47.06％），留置尿管（41．18％）、留置静脉导管及体腔引流管（41。18％）、持续使用广谱抗菌药物（76。47％）、化疗（17．65％）、进入ICU治疗（29．41％）及粒细胞减少（29．41％）为可能相关因素；死亡率70。59％。结论 非白色念珠菌属感染比例增多，中心静脉插管与深部真菌感染相关性可能更强，应早期开始经验性治疗，目前临床应用氟康唑抗真菌治疗剂量偏小。

OBJECTIVE To analyze predisposing factors and investigate the measures to fungemia. METHODS The clinical features, therapy and outcome of 17 patients with fungemia which happened from 1995 to 2004 were retrospectively reviewed. RESULTS The morbidity of fungemia was 5.52~ in all septicemia in our hospital. Can- dida tropicalis and C. albicans were the major fungal species. There were 6 patients found cultured fungi on local loci. Tracheotomy and mechanical ventilation （47. 06%）, indwelling urinary catheter （41. 18%）, indwelling central venous catheter and drainage tube （41. 18%）, persisted use of broad spectrum antibiotic （76. 47%）, chemical therapy （17.65%）, admission to ICU （29.41%）, and neutropenia （29.41%） might be the predisposing factors. The mortality of fungemia was 70.59%. CONCLUSIONS The morbidity of non-C, albicans fungemia is increasing, preemptic therapy should be begun earlier. Higher dose of fluconazole may be recommended in clinical usage.