摘要
目的分析真菌血流感染的临床特征,进一步探讨真菌血流感染的防治措施。方法对2003—2008年医院诊断的真菌血流感染57例进行回顾性临床分析。结果白念珠菌是真菌血流感染的主要病原体,占42.1%;真菌血流感染的发生与广谱抗生素应用、中心静脉置管、恶性肿瘤和使用免疫抑制剂有关;治疗有效率为50.0%,7例患者在未治疗前病情恶化死亡,总病死率为56.1%。预后相关因素分析提示使用过卡泊芬净与两性霉素B治疗明显利于患者生存,而高APACHE评分、未行抗真菌治疗及行全胃肠外营养患者病死率较高。结论广谱抗菌药使用、中心静脉插管与真菌血流感染相关性可能更强;对氟康唑治疗无效的患者应尽早更换为两性霉素B或棘白菌素类。
Objective To analyze the clinical characteristics of bloodstream infection （BSI） caused by fungal agent and discuss the prevention and treatment strategy. Methods Patients （n = 57） with diagnosis of fungal BSI in our hospital during year 2003 and 2008 were retrospectively analyzed. Results C. albicans was the most common causative pathogen, accounting for 42.1 %of all the fungal pathogens. Fungal BSI was associated with multiple factors, including prior use of broad-spectrum antibiotics, placement of central venous catheter, malignant tumors and immunosuppressant agents. Treatment was effective in 50.0 % of the patients. Seven patients died before antifungal treatment due to exacerbation. The all-cause mortality was 56.1%. The analysis of prognostic factors showed that the outcome was better when patients received non-triazole agents （caspofungin or am photeriein B） than when patients received triazole agents. The mortality was high in those patients with high APACHE scores, total parenteral nutrition, or without anti-fungal treatment. Conclusions The fungal BSI was more associated with prior use of broad-spectrum antibiotics and placement of central venous catheter. It is necessary to switch to amphotericin B or echinocandin therapy when patients are resistant to fluconazole.
出处
《中国感染与化疗杂志》
CAS
2009年第3期228-232,共5页
Chinese Journal of Infection and Chemotherapy
关键词
真菌血流感染
氟康唑
卡泊芬净
两性霉素B
经验性治疗
fungal bloodstream infection
fluconazole
caspofungin
amphotericin B
empirical treatment
