肿瘤医院呼吸机相关性肺炎的真菌感染特点分析

Analysis of characteristics about ventilator-associated pneumonia caused by fungi in cancer hospital

目的:探讨肿瘤医院呼吸机相关真菌性肺炎(VAP-F)发生的临床与病原菌特点,为临床提供指导。方法:选取中山大学肿瘤防治中心2006-01-2009-09ICU住院并行机械通气时间>48h,ICU收治时间>7d,且于ICU治疗期间始终未出现中性粒细胞缺乏、免疫抑制的肿瘤患者,排除输入性真菌感染或已行预防性抗真菌治疗者,其中拟诊真菌感染者为VAP-F组,其余设为对照组。结果:按标准共收集病历44例,VAP-F组20例,对照组24例,VAP-F发生率为45.45%(20/44),最常见菌为白色念珠菌12例(60.0%),近平滑念珠菌4例(20.0%),光滑念珠菌3例(15.0%),热带念珠菌1例(5.0%)。所合并细菌以革兰阳性菌(64.7%)为主。两组间呼吸机通气时间、年龄及是否合并细菌感染差异有统计学意义(P<0.05),而患者体质量、是否行胃肠道手术、术前术后肺功能氧合指数(OI)及其变化等指标两组间差异无统计学意义。Logistic回归分析表明,是否合并细菌感染是吸机相关真菌性肺的独立危险因素。结论:肿瘤患者VAP-F的发生与是否合并细菌感染有关,若临床已行针对细菌治疗,建议同时行预防性抗真菌治疗。

OBJECTIVE：To analyze the clinical and pathogenic characteristics of ventilator-associated pneumonia caused by fungi （VAP-F） in the ICU of Sun Yat-sen University Cancer Center.METHODS：The cancer patients ventilated mechanicaly over 48 hours and stayed at least 7 days in the ICU of our Cancer Center from January 2006 to September 2009 were included in the study.The VAP-F group was composed of the cases in accord with the diagnosis of probable fungal infection,while the rest VAP patients without fungal infection were considered as the controls.Those patients with neutropenia,immunosuppression,fungal infection or given prophylactic therapy prior to ventilation were excluded.RESULTS：Forty-four VAP cancer patients were included in the study,in which 20 （45.45%） met the standard of probable fungal infection,while the rest 24 cases were VAP caused by bacterial infection.The pathogens of fungi were C.albicans,C.parapsilosis,C.glabrate and C.tropicalis 12 strains,with their strains amounting to be 12 （60.0%）,4 （20.0%）,3 （15.0%） and 1 （5.0%） respectively.Gram-positive germs were the main bacterial strains accompanying the fungal infeciton （64.7%）.The age,time-interval and bacterial co-infection were factors that were significantly different between the VAP-F patients and their controls （P0.05）.Other factors such as weight,oxygenation index （OI） and gastroabdominal operation did not show significant difference,and the logistic regression showed that bacterial co-infection was an independent risk factor for VAP-F.CONCLUSIONS：Among cancer patients,VAP-F occurrence is closely related to the bacterial co-infection.Prophylactic therapy against fungal infection should therefore be suggested to accompany anti-bacterial VAP therapy as well.