外科重症监护病房10年间侵袭性曲霉菌感染的临床监测
외과중증감호병방10년간침습성곡매균감염적림상감측
The clinical monitoring of invasive aspergillosis in surgical intensive care unit during 10 years
  • 万方数据
    中华危重病急救医学 중화위중병급구의학
    Chinese Critical Care Medicine
    2014年 9期 634-638 ,共5页

    徐宁%李双玲%冯汝立%王东信

    서저%리쌍령%풍여립%왕동신

    侵袭性曲霉菌感染%外科重症监护病房%危险因素%预后 侵襲性麯黴菌感染%外科重癥鑑護病房%危險因素%預後
    침습성곡매균감염%외과중증감호병방%위험인소%예후
    Invasive aspergillosis%Surgical intensive care unit%Risk factor%Prognosis
    目的 分析外科重症监护病房(SICU)侵袭性曲霉菌感染(IA)的流行病学特点.方法 回顾性分析2004年1月至2013年12月10年间北京大学第一医院SICU内IA患者的临床资料,包括一般情况、手术种类、霉菌种类、感染部位、临床表现、治疗与预后等.结果 10年间北京大学第一医院SICU共收治8 220例患者,其中29例发生IA,发生率为0.35％; IA院内感染率为0.27％(22/8 220);IA院内感染占同期SICU院内感染的6.98％(22/315).与2004年至2008年相比,2009年至2013年每5年院内感染率明显降低[3.19％(137/4 293)比4.53％(178/3 927),x2＝10.020,P=0.002],IA发生率[0.56％(24/4 293)比0.13％(5/3 927),x2=10.874,P=0.001]、IA院内感染率[0.40％(17/4 293)比0.13％(5/3 927),x2=5.556,P=0.019]、IA院内感染占同期院内感染的比例[12.41％(17/137)比2.81％(5/178),x2=10.982,P=0.001]明显升高.在29例IA患者中,手术后发生者25例,以普外科手术为主(13例),其次为肾移植术后(6例)和胸外科术后(3例).29例IA患者155份送检标本中共检出曲霉菌17株,其中烟曲霉2株,其余15株未进一步分型;常见感染部位以下呼吸道为主(23例,占79.31％);半乳甘露聚糖实验(GM实验)阳性16例.在所有危险因素中,以长期使用广谱抗菌药物比例最高[占36.25％ (29/80)],其次为长期使用激素[占18.75％(15/80)]、合并肾损伤[占18.75％(15/80)]、合并肝损伤[占13.75％(11/80)]、长期口服免疫抑制剂[占7.50％(6/80)]、合并粒细胞减少[占5.00％(4/80)].29例IA患者中除1例未经治疗外,其余均进行抗真菌治疗,其中单用伊曲康唑1例,单用棘白菌素类药物3例,单用两性霉素B脂质体5例,单用伏立康唑8例,单用安浮特克或棘白菌素类药物后更换为伏立康唑8例,棘白菌素类药物和伏立康唑联合用药3例.29例IA患者中死亡17例,病死率为58.62％.结论 近5年IA发生率在SICU有明显上升趋势,感染部位以呼吸道为主,病死率较高,应引起临床医生高度重视.
    목적 분석외과중증감호병방(SICU)침습성곡매균감염(IA)적류행병학특점.방법 회고성분석2004년1월지2013년12월10년간북경대학제일의원SICU내IA환자적림상자료,포괄일반정황、수술충류、매균충류、감염부위、림상표현、치료여예후등.결과 10년간북경대학제일의원SICU공수치8 220례환자,기중29례발생IA,발생솔위0.35％; IA원내감염솔위0.27％(22/8 220);IA원내감염점동기SICU원내감염적6.98％(22/315).여2004년지2008년상비,2009년지2013년매5년원내감염솔명현강저[3.19％(137/4 293)비4.53％(178/3 927),x2＝10.020,P=0.002],IA발생솔[0.56％(24/4 293)비0.13％(5/3 927),x2=10.874,P=0.001]、IA원내감염솔[0.40％(17/4 293)비0.13％(5/3 927),x2=5.556,P=0.019]、IA원내감염점동기원내감염적비례[12.41％(17/137)비2.81％(5/178),x2=10.982,P=0.001]명현승고.재29례IA환자중,수술후발생자25례,이보외과수술위주(13례),기차위신이식술후(6례)화흉외과술후(3례).29례IA환자155빈송검표본중공검출곡매균17주,기중연곡매2주,기여15주미진일보분형;상견감염부위이하호흡도위주(23례,점79.31％);반유감로취당실험(GM실험)양성16례.재소유위험인소중,이장기사용엄보항균약물비례최고[점36.25％ (29/80)],기차위장기사용격소[점18.75％(15/80)]、합병신손상[점18.75％(15/80)]、합병간손상[점13.75％(11/80)]、장기구복면역억제제[점7.50％(6/80)]、합병립세포감소[점5.00％(4/80)].29례IA환자중제1례미경치료외,기여균진행항진균치료,기중단용이곡강서1례,단용극백균소류약물3례,단용량성매소B지질체5례,단용복립강서8례,단용안부특극혹극백균소류약물후경환위복립강서8례,극백균소류약물화복립강서연합용약3례.29례IA환자중사망17례,병사솔위58.62％.결론 근5년IA발생솔재SICU유명현상승추세,감염부위이호흡도위주,병사솔교고,응인기림상의생고도중시.
    Objective To investigate the invasive aspergillosis (IA) status in a surgical intensive care unit (SICU).Methods The clinical data including general state,operation,pathogenic microorganisms,infection position,clinical situation,treatment and prognosis of patients with IA admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were retrospectively analyzed.Results 8 220 patients admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were enrolled.Of 8 220 patients,there were 29 cases experienced IA,with an incidence of 0.35％,and the incidence of hospital onset of IA infection was 0.27％ (22/8 220).The incidence of hospital onset of IA infection was accounted for 6.98％ (22/315) of the incidence of hospital onset of infection in SICU in the same period.Compared with 2004-2008,in 2009-2013,the incidence of hospital onset of infection was significantly decreased [3.19％ (137/4 293) vs.4.53％ (178/3 927),x2=10.020,P=0.002],while the incidence of IA [0.56％ (24/4 293) vs.0.13％ (5/3 927),x2=10.874,P=0.001],the incidence of hospital onset of IA infection [0.40％ (17/4 293) vs.0.13％ (5/3 927),x2=5.556,P=0.019],and the percentage of incidence of hospital onset of IA infection according to the incidence of hospital onset of infection were increased by 5 years [12.40％ (17/137) vs.2.81％ (5/178),x2=10.982,P=0.001].Of 29 patients with IA,25 cases had occurred after operation,and the majority of them were from the Department of General Surgery (13 cases),and followed by post-renal transplantation (6 cases) and post-thoracic surgery (3 cases).In the total submission of 155 specimens from 29 patients with IA,there were 17 strains isolated aspergillosis,among which included 2 strains of Aspergillus fumigatus,and 15 other un-subgrouped strains.The most common infection site was lower respiratory tract (23 cases,79.31％).Sixteen patients were found with positive galactomannan (GM) test.In all the risk factors contributing to IA,the ratio of the long-term usage of broad-spectrum antibiotics over 4 days was the highest [36.25％ (29/80)],which followed by the long-term use of hormone [18.75％ (15/80)],complicated with acute kidney injury [18.75％ (15/80)],liver injury [13.75％ (11/80)],the long-term use of immunosuppressive orally [7.50％ (6/18)],and complicated with neutropenia [5.00％ (4/80)].In 29 patients with IA,there were 28 patients received anti-fungal treatment except for 1 patient without treatment,and those were single use of itraconazole in 1 case,single use of echinocandins in 3 cases,single use of liposomal amphotericin B in 5 cases,8 cases with voriconazole,single use of liposomal amphotericin B or echinocandins then replaced by voriconazole in 8 cases,and 3 cases of echinocandins therapy combined with voriconazole.Seventeen of 29 patients died,with a mortality rate of 58.62％.Conclusions IA is an uncommon but increasing postoperative complication of patients in SICU in recent 5 years.The most common sites of IA were lower respiratory tract.The mortality of IA is very high.So clinicians should pay more attention to the careful monitor for IA.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문