院内真菌感染149例分析

Nosocomial fungal infections, analysis of 149 cases

目的 探讨院内真菌感染尤其是深部真菌感染的临床表现、诊断及治疗方法。方法 对 1981年 12月至 2 0 0 1年 11月间经微生物学检查证实的 149例院内真菌感染患者的临床资料进行回顾性分析。结果 在 149例院内真菌感染的病例中有 134例为深部真菌感染 ,所有病例均有基础疾病 ,以原发肺部疾病 ( 2 9例 )、神经系统疾病 ( 2 4例 )、风湿性疾病 ( 2 0例 )以及血液病 ( 18例 )最多见 ;其感染的常见诱因有长期使用广谱抗生素 ( 37例 )或糖皮质激素 ( 2 9例 )及免疫抑制剂 ( 17例 )、化疗( 10例 )、气管切开或气管插管 ( 12例 ) ;感染的部位依次为肺部、脑膜及脑实质、血液等 ;感染的病原菌仍以白念珠菌、热带假丝念珠菌、新型隐球菌、曲霉菌等为主 ,但一些少见的真菌如葡萄牙念珠菌、季也蒙念珠菌也在临床上分离出来 ;在临床上 6 3 76 %的病人有发热 ,白细胞增高者占 39 6 % ;单纯用氟康唑、两性霉素B和伊曲康唑治疗者分别为 74例、5例和 16例 ,其余病例均采用联合治疗 ;治愈 6 7例、好转 2 9例、死亡 44例 ( 2 9 5 3% ) ;近年真菌感染的发生率明显增高 ,1996～ 2 0 0 1年共 75例 ,占5 0 34%。结论 近年来真菌感染有逐年增加的趋势 ,这与长期大剂量广谱抗生素、大剂量糖皮质激素以及免疫抑制剂应用、化疗?

Objective To investigate the manifestation, diagnosis, antifungal therapy and outcome of nosocomial fungal infections. Methods The clinical data of 149 patients with nosocomial fungal infections admitted in the PUMC hospital from Dec. 1981 to Nov. 2001, 67 males and 82 females with an average age of 52.32 years, including the manifestation, diagnosis, treatment and outcome, were reviewed retrospectively. Results 134 out of the 149 patients suffered from deep mycoses. All cases had underlying conditions, including primary pulmonary diseases (n=29), rheumatic disease (n=20), hematological disease such as leukemia or lymphoma (n=18), HIV infection/AIDS (n=13), major surgery (n=10), and intracerebral hemorrhage or cerebral infarction (n=24). The predisposing factors or risk factors for deep mycoses included use of high dose broad-spectrum antibiotics over a long period (n=37), steroids/cytotoxic chemotherapy (n=29), immunosuppressant (n=17), chemotherapy (n=10), intravenous lines and incubation (n=36), and tracheotomy or endotracheal intubation (n=12). The infectious sites were lung, meninges, cerebral parenchyma, blood, etc. in the order of prevalence. Depending on infectious site and type of fungus, the clinical manifestations included fever (63.76%), respiratory symptom such as cough (37.58%), leucocytosis (39.6%), chest X-ray images (24.49%) etc. CNS fungal infection included meningitis, brain abscess, and granuloma. Meningitis due to Cryptococcus resembled that due to Mycobacterium tuberculosis. The main pathogenic fungal species were Candida albicans, C. tropicalis, C. parapsilosis, C. neoformans, and Aspergillus species. Amphotericin B, fluconazole, and flucytosine were used alone or in combination. The overall mortality rate was 29.53% (44/149). Out of the 149 patients 67 were cured, 29 made improvement. The incidence of fungal infection remarkably increased recently with 75 cases appearing in the past 5 years (50.34%). Conclusion The incidence of fungal infection is increasing recently which is correlated with use of high dose broad-spectrum antibiotics over a long period, high dose steroids/cytotoxic chemotherapy, immunosuppressant, chemotherapy, and improvement of examination skills, etc. The main pathogens are still Candida albicans and non-albicans Candida species. Early diagnosis is very important.