造血系统恶性疾病并发真菌败血症临床分析

Fungemia in Patients with Malignant Hematopoietic Diseases: A Clinical Study

目的 探讨造血系统恶性疾病并发真菌败血症的防治措施。方法 回顾性分析近 6年来 18例造血系统恶性疾病并发真菌败血症患者的临床情况。结果 真菌败血症占血液系统医院感染的 3.7%,热带念珠菌是主要菌种 ,占 72 .2 %,病死率达 38.9%,真菌败血症的发生与原发病、强烈化疗、大剂量免疫抑制剂及抗生素长期反复应用有关 ;氟康唑、两性霉素B +5 氟胞嘧啶治疗有效率分别为 14.3 %、6 3.6 %。结论 非白色念珠菌败血症有增多之势 ,尽早明确诊断、及时防治是关键 ,治疗首选两性霉素B +5 氟胞嘧啶。

OBJECTIVE To investigate predisposing factors and measures of fungemia in patients with malignant hematopoietic diseases. METHODS To retrospectively review the clinical features, treatment and outcomes of 18 patients. RESULTS The rate of nosocomial infections of hematopoietic diseases suffered from fungemia was 3.7%; major fungal species were Candida tropicalis (72.2%) and C. albicans; the death rate was 38.9%; the causes of fungemia were associated with severe underlying diseases, intensive chemotherapy, high dose immunosuppressive agents and prolonged broad-spectrum antibiotic administration; effective rate of fluconazole and amphotericin B plus flucytosine to fungemia was 14.3% and 63.6%, respectively. CONCLUSIONS Non-Candida albicans fungemia was insceasing; early removing predisposing factors, monitoring fungal pathogen and antifungal therapy were often necessary in patients with fungemia; amphotericin B plus flucytosine were still recommended as the first choice for fungemia treatment.