摘要
目的分析粒细胞缺乏合并深部真菌感染患者的临床特点与治疗方法。方法回顾性分析2010年1月-2013年4月收治的42例粒细胞缺乏合并深部真菌感染患者临床资料,总结其临床治疗要点。结果 42例患者感染部位分泌物样本中共检出46株真菌,其中占60.87%为白色假丝酵母菌,其次为曲霉菌属占17.39%;33.33%合并ESBLs大肠埃希菌败血症,19.05%合并金黄色葡萄球菌性肺炎;42.86%患者在治疗过程中出现一过性谷丙转氨酶升高,23.81%患者出现恶心、食欲下降等不良反应;经抗真菌治疗后,12例患者治愈,治愈率28.57%,11例患者为显效,显效率26.19%,13例患者死亡,病死率30.95%;治疗总有效率为54.76%。结论粒细胞缺乏伴深部真菌感染根据病原菌鉴定及药敏试验结果选择合理的抗菌药物;临床高度怀疑真菌感染病时应给予预防性抗真菌治疗;对常规抗真菌药物治疗不佳时使用伏立康唑、伊曲康唑等新型抗真菌药物。
OBJECTIVE To analyze the clinical characteristics of the agranulocytosis patients complicated with deep fungal infections and propose treatment measures.METHODS A total of 42agranulocytosis patients complicated with deep fungal infections who were treated in the hospital from Jan 2010to Apr 2013were enrolled in the study,then the clinical data of the subjects were retrospectively analyzed,and the clinical treatment approaches were summarized.RESULTS Totally 46strains of fungi have been isolated from the secretion specimens obtained from 42patients,among which the Candida albicans accounted for 60.87%,followed by the Aspergillus（17.39%）.Of the patients,33.33% were complicated with ESBLs-producing Escherichia coli sepsis,19.05%complicated with Staphylococcus aureus pneumoniae.42.86% of the patients presented the transient increase in ALT during the treatment,and 23.81% had the adverse events such as nausea and loss of appetite.After the anti-fungal treatment,12cases were cured with the cure rate of 28.57%,11cases were improved with the effective rate of 26.19%,13cases died with the mortality rate of 30.95%,and the total effective rate of treatment was 54.76%.CONCLUSION As for the treatment of the agranulocytosis patients complicated with deep fungal infections,it is necessary to reasonably use antibiotics on the basis of the results of the identification of pathogens and drug susceptibility testing,perform anti-fungal treatment prophylaxis for the patients with highly suspected fungal infections,and use novel anti-fungal drugs such as voriconazole and itraconazole when the conventional anti-fungal drugs are incapable of achieving good therapeutic effect.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第14期3447-3449,共3页
Chinese Journal of Nosocomiology
基金
济南市卫生局专项基金资助项目(SJ-2010A-1022)
关键词
粒细胞缺
深部真菌感染
临床分析
抗菌药物
Agranulocytosis
Deep fungal infection
Clinical analysis
Antibiotic
