外科重症治疗病房中侵袭性真菌感染分析

Retrospective analysis of invasive fungal infection in surgical intensive care unit

目的分析外科重症治疗病房（SICU）患者侵袭性真菌感染（IFI）的情况。方法回顾性分析北京大学人民医院SICU 2003年1月至2008年12月间收治的3743例患者真菌感染相关的资料，其中住ICU时间≥48h的271例患者常规进行了真菌学检查。结果诊断为院内IFI患者共75例，感染率2．00％（75／3743），真菌血症发生率0．27％（10／3743），死亡37例，病死率49．33％（37／75）。各年感染率比较P=0．420，差异无统计学意义；病死率2007年及2008年升高，与以往各年比较差异均有统计学意义（均P〈0．05）。75例患者中34例为泌尿道感染，37例为肺部感染，10例发现真菌血症，1例为导管相关真菌感染，2例为腹腔感染，2例为胆道感染。11例患者有2个部位发生真菌感染。检出致病真菌86株，其中自念珠菌40株（46．51％），光滑念珠菌19株（22．09％），热带念珠菌12株（13．95％），近平滑念珠菌7株（8．14％），克柔念珠菌3株（3．49％），毛霉菌4株（4．65％），曲霉菌1株（1．16％）。机械通气时间≥3d,合并细菌感染、使用广谱抗生素或联用3种及以上抗生素是患者发生IFI的高危因素，预防性抗真菌治疗可能有保护作用。结论我院SICU患者总体IFI发病率较低，真菌血症发生率较低；发生IFI后患者死亡率明显增高；感染部位主要在肺部和泌尿道，致病真菌主要为念珠菌；机械通气、合并细菌感染、抗生素使用是SICU患者发生IFI的重要危险因素。

Objective To conduct a restrospective analysis of the invasive fungal infection （IFI） in surgical intensive care unit （SICU）. Methods The IFI data of the patients who were admitted in SICU during January 2003 to December 2008 was retrospectively analyzed. A total of 3743 patients were admitted into SICU. Among them, 271 patient＇s SICU duration was more than 48 hours, who had fungi examination. Results Seventy-five patients were diagnosed IFI, the morbidity was 2. 00% （75/3743） , the incidence of fungemia was 0. 27% （10/3743）, the mortality of IFI patients was 49.33% （37/75）. The morbidity rate of each year was almost the same. The mortality of 2007 and 2008 was higher than before （ both P 〈 0. 05 ）. Thirty-four of all the 75 IFI patients got urinary tract infected, 37 got fungal pneumonia, 10 got fungemia, 1 got catheter-related fungal infection, 2 got fungal infection in abdomen, 2 got biliary tract infected. Eightysix fungi strains which caused fungal infection were spotted. Candida albicans was the most common isolate （46. 51% ）. Other isolates were Candida glabrata （22. 09% ）, Candida tropicalis （ 13.95% ）, Candida parapsilosis （8. 14% ）, Candida krusei （3.49%）, Trichosporon （4. 65% ）, Aspergillus （ 1.16% ）. Assist ventilation, combination of bacterial infection, treatment by broad spectum antibiotics or more than three kinds of antibiotics were the most important risk factors of IFI in SICU. Prophylactic antifungal treatment may be useful. Conclusion The morbidity of IFI in our SICU was comparatively low, and the same of the incidence of fungemia. The mortality of IFI patients was markedly high. The main sites of infection were lung and urinary tract, and the pathogenic fungi strains were mostly Candidas. Assist ventilation, combination of bacterial infection, broad speetum antibiotics treatment were the most important risk factors of IFI in SICU.