侵袭性真菌病33例分析

Invasive fungal disease:report of 33 cases

目的探讨侵袭性真菌病(invasive fungal disease,IFD)的临床特点和防治方法。方法回顾性分析2009年1月—2010年12月符合IFD确诊标准的33例临床资料,了解其发生率、临床特征、相关因素、治疗方法和预后的关系。结果本组IFD 33例占同期住院患者的0.048%;死亡10例;病死率为30.3%。白念珠菌感染居IFD首位(19例,57.5%),其次为热带念珠菌(7例,21.2%)。患者自身营养状态下降,留置侵袭性导管,机械通气>48 h,使用广谱抗生素及存在其他相关因素的情况下易发生IFD。抗真菌治疗较多使用的是三唑类和棘白菌素类药物。结论 IFD的病死率较高,减少不必要的侵袭性操作,保护患者自身免疫屏障,对高危患者加强预防和监测,可提高侵袭性真菌病的防治水平。

Objective To review the clinical features and control methods of invasive fungal disease （IFD）. Methods We conducted a retrospective analysis of 33 cases of proven IFD during January 2009 and December 2010 to further understand the incidence, clinical features, risk factors, treatment and prognosis of the disease. Results The incidence of IFD was 0. 048%. The mortality was 30.3%. Candida albicans was the most frequently isolated pathogen （57.5%）, followed by Candida tropicalis （21.2%）. Patients were prone to IFD when they had decreased nutritional status, indwelling catheter, mechanical ventilation for more than 48 hours and use of broad-spectrum antibiotics. Azoles and echinocandins were used for antifungal therapy in most cases. Conclusions Patients with IFD had high mortality. It is important to avoid the unnecessary invasive procedures, protect patient＇s own immune barriers and put an emphasis on prevention and monitoring to improve the outcomes.