SICU侵袭性真菌感染临床监测研究

Clinical monitoring of invasive fungal infections in SICU

目的调查外科重症监护病房(SICU)侵袭性真菌感染及菌种演变趋势,以便今后更好地实施早期治疗和干预处理,改善患者预后。方法记录并分析2003年1月-2013年7月外科重症监护病房侵袭性真菌感染282例患者的临床资料,包括一般情况、手术种类、侵袭性真菌感染的部位、真菌种类及耐药性、临床治疗与预后等。结果入选282例患者送检490份标本共分离出500株真菌,侵袭性真菌感染以白色假丝酵母菌居首位占51.3%、非白色假丝酵母菌占45.4%、真菌占3.3%;真菌感染最常见的部位依次为下呼吸道39.0%、手术切口20.4%、泌尿道19.0%、血流感染10.2%;排名前4位的假丝酵母菌属为白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌、近平滑假丝酵母菌;引起假丝酵母菌血症的菌株依次为白色假丝酵母菌、近平滑假丝酵母菌、光滑假丝酵母菌,非白色假丝酵母菌逐年增加(χ2=18.733,P<0.001)。结论侵袭性真菌感染是外科重症监护病房常见的术后并发症,临床医师应做到早期诊断、及时治疗,10年致病真菌种类发生改变,治疗时真菌药物的选择需考虑覆盖非白色假丝酵母菌。

OBJECTIVE To investigate the prevalence of invasive fungal infections in surgical intensive care unit （SICU ） and observe the trend of variation of the fungal species so as to carry out the early treatment ,take inter-vention measures ,and improve the prognosis of the patient .METHODS A total of 282 patients with invasive fungal infections ,who were treated in the SICU from Jan 2003 to Jul 213 ,were enrolled in the study ,then the clinical data including the general status ,type of surgery ,invasive fungal infection site ,species of fungi ,drug resistance , clinical treatment ,and prognosis were recorded and analyzed .RESULTS Totally 500 strains of fungi have been iso-lated from 490 submitted specimens that were obtained from the 282 included patients ,among which the Candida albicans ranked the first place （51 .3% ） ,followed by the non-C .albicans （45 .4% ） and the rest species of fungi （3 .3% ） .The lower respiratory tract ,surgical site ,urinary tract ,and bloodstream were the most common fungal infection sites ,accounting for 39 .0% ,20 .4% ,19 .0% ,and 10 .2% ,respectively .The C .albicans ,Candida tropicalis ,Candida glabrata ,and Candida parapsilosis ranked the top four species of Candidaspp .The candi-demia was respectively caused by the C .albicans ,C .parapsilosis ,and C .glabrata;the non-C .albicans strains was increased year by year （χ2 = 18 .733 ,P〈 0 .001） .CONCLUSION The invasive fungal infection is a common postoperative complication in the SICU ;it is necessary for the clinician to carry out the diagnosis and treatment in early stage ,the species of pathogenic fungi have varied in the ten years ,and the non-C .albicans strains should be considered to cover when the antifungal drugs are used for the treatment .