摘要
目的通过分析内科重症监护病房(MICU)患者真菌感染与抗真菌药物使用的相关性,指导临床医生更好地把握治疗时机进行正确的早期经验性抗真菌治疗。方法对2009年5月—2013年3月在我院呼吸科MICU住院的真菌阳性和/或应用抗真菌药的278例患者相关病历资料进行回顾性分析。278例患者中,真菌阳性但未应用抗真菌药的患者71例;真菌阳性且应用抗真菌药的患者93例;真菌阴性但应用抗真菌药的患者114例。结果以慢性阻塞性肺疾病急性加重期(AECOPD)(22.7%,63/278)为主的呼吸系统疾病继发的真菌感染最常见,白色念珠菌(186株)为主要致病菌。临床上主要应用唑类抗真菌药(67.6%,192/284),并以早期经验性治疗(190例)为主。在164例真菌阳性的患者中,比较应用抗真菌药组和未用抗真菌药组患者的预后发现,应用真菌药与否对患者的预后影响不大(P=0.183)。而在71例真菌阳性但未进行抗真菌治疗的患者中,通过对比有临床表现组和无临床表现组发现,无临床表现患者的预后好于有临床表现的患者(P=0.008)。在207例应用抗真菌药的患者中,查到真菌前(即经验性治疗)与查到真菌后(即先发治疗和目标治疗)开始抗真菌治疗的患者预后差异无统计学意义(P=0.365)。在190例经验性抗真菌治疗的患者中,真菌阳性组与真菌阴性组的患者预后差异无统计学意义(P=0.667)。结论对于具有真菌感染高危因素的重症患者,不应过分依赖病原学结果,应以患者是否具有真菌感染相应的临床表现作为是否开始抗真菌治疗的主要依据。当患者出现真菌感染相应的临床表现,但无真菌学依据时,应以临床表现为主,积极进行经验性抗真菌治疗。但是当真菌阳性时,应仔细审视患者是否具有真菌感染相应的临床表现而决定是否开始治疗。
Objective To guide clinicians to better grasp the correct timing of treatment of early empirical antifungal therapy by analyzing the correlation of fungal infections and the usage of antifungal agents of MICU patients. Methods Retrospectively analyze the relevant medical records of 278 patients with mycology positive and/or the usage of antifungal agents, who were hospitalized in our MICU from May 2009 to March 2013. Among the 278 patients, mycology positive patients without using anti- fungal agents were 71, mycology positive patients with antifungal agents were 93, mycology negative without using antifungal a- gents were 114. Results Fungal infection secondary to AECOPD （22.7%, 63/278） respiratory disease was most common and monilia albicans was the main pathogen （ 186 strains） . The most frequently used medicine was Azole antifungal agents （67. 6% 192/284 ） and it was mainly treated by early empirical therapy （190） . There was little impact on prognosis between application of antifungal agents and unused antifungal agents groups in the 164 mycology positive patients （P = 0. 183 ） . It was better prognosis with clinical manifestations than without clinical manifestations in the 71 mycology positive but not using antifungal patients （ P = 0. 008 ）. There was no significant difference of prognosis between empirical therapy group and preemptive and target therapy group in the 207 patients with application of antifungal agents （P = 0. 365） . There was no significant difference of the prognosis between mycology positive group and mycology negative group among the 190 patients taking early empirical treatment （P = 0. 667） . Conclusion When to start early empirical antifungal therapy is mainly based on the corresponding manifestations of fungal infection, rather than etiology result, especially for the MICU patients with high risk factors.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第25期3013-3016,3020,共5页
Chinese General Practice
基金
沈阳市科学技术项目(F12-193-9-02)
国家自然科学基金资助项目(30770956)
关键词
内科重症监护病房
真菌感染
抗真菌药
经验性用药
Medical intensive care unit Fungal infection Antifungal drugs Empirical treatment
