心脏直视术后肺部真菌感染临床分析

Nosocomial Pulmonary Fungal Infection after Open Heart Surgery:A Clinical Analysis

目的探讨心脏手术后肺部真菌感染的相关因素及治疗。方法回顾2004年1月-2006年12月324例心脏直视手术后发生医院感染病例的临床资料。结果共发生肺部真菌感染61例,占同期医院感染的18.8%,患者均病情危重且使用过广谱抗菌药物及糖皮质激素,36例患者机械通气时间>1周;白色假丝酵母菌最多见,其次为光滑假丝酵母菌,药敏结果显示,氟康唑、伊曲康唑及5-氟胞嘧啶等具有良好的抗菌活性。结论心脏手术后肺部真菌感染呈增加趋势,其发病与基础疾病严重、长时间机械通气、使用广谱抗菌药物等密切相关。

OBJECTIVE To investigate the risk factors and treatment of nosocomial pulmonary fungal infection after open heart surgery. METHODS A total of 11040 consecutive patients who underwent open heart surgery were retrospectively studied from Jan 2004 to Dec 2006. And the clinical data of 324 patients with microbiologically documented nosocomial infection were analyzed. RESULTS There were 61 infected cases caused by fungi, accounted for 18. 8% of all infections during the same period. Sixteen patients died. All infected patients had serious original heart diseases,and received previously glucocorticoids and broad-spectrum antibiotic therapy. The number of senile and pediatric patients was 28. Forty three patients developed posteardiotomy eardiorespiratory and renal function failures, and circulatory assist was established in 22 patients. Thirty six patients prolonged mechanical ventilation time for over one weeks. Thirty four patients developed hyperglycosemia. Candida albicans was the predominant pathogen （39 strains, 63.9%）,followed by C. glabrata（15 strains, 24. 6%）. Results of susceptibility test showed that fluconazole, itraconazole and flucytosine presented highly antimicrobial activity. CONCLUSIONS Developments of nosocomial pulmonary fungal infection is closely associated with the severity of preoperative underlying heart diseases, prolonged mechanical ventilation and longer period of broad-spectrum antibiotic therapy.