ICU内患者获得性真菌感染的防治

The prevention and treatment of mycotic infection in intensive care units

目的：研究长期住ＩＣＵ患者获得性深部真菌感染的发生特点及防治对策。方法：回顾性分析１９９５年１月～１９９７年１２月我院ＳＩＣＵ连续长期住院患者６５例，定期采取呼吸道（痰液）、血液、尿液、中心静脉插管、各种引流及伤口深部拭子标本，行微生物培养及药敏试验。结果：６５例患者中微生物培养阳性者４９例（７５．４％）；其中单纯真菌感染者２例（３．１％）；真菌合并细菌感染者１８例（２７．７％）。真菌感染的总发生率为４０．８％（２０／４９）。共获得真菌４１株，念珠菌属仍是主要感染病原体，占全部４１株的５６．１％以上，但白色念珠菌感染比例显著下降。结论：ＩＣＵ中真菌感染最常见于呼吸道和泌尿道，感染发生率与患者年龄、留治时间及机械通气时间有关。应用广谱强力抗生素可以造成菌群失调而引发深部真菌感染。

Objective:To investigate the characteristics and prevention of nosocomial infection with deep mycosis in intensive care units.Methods:From Jan.1995 to Dec.1997,samples from sputum,blood,urine,central venous catheter,wound drainage,as well as feces were collected for microbiological examination and drug sensitive test in 65 consecutive patients who were treated in surgical ICU.Results:Positive microbiological culture was found in 49 cases (75 4%),in which 2 cases had mycotic infection (3 1%),18 cases had mycotic and bacterial mixed infection (27 7%).The total positive rate of mycotic infection was 40 8% (20/49 cases),and 41 strains were isolated from those patients.Candida was still the predominant pathogenic organism in mycotic infection (56 1%),but the incidence of Candida albicans infection was markedly decreased.Conclusions:Mycotic infection can commonly occur in respiratory and urinary tract,and the incidence of nosocomial infection appears to be related to the age,hospitalized days,and duration for mechanical ventilation in ICU.Incorrect use of broadspectrum antibiotics may cause imbalance of microbial flora,subsequently leading to deep mycotic infection.Candida albicans is not the main pathogenic fungus associated with deep mycotic infection in surgical ICU.