肿瘤重症患者侵袭性肺部真菌感染危险因素分析  

Risk factors for invasive pulmonary fungal infections in sever tumor patients

作　　者：汪道峰[1,2] 娄宁[1,2] 李小东[1,3] 

机构地区：[1]华南肿瘤学国家重点实验室,广东广州510060 [2]中山大学肿瘤防治中心ICU,广东广州510060 [3]中山大学肿瘤防治中心胸科,广东广州510060

出　　处：《中华医院感染学杂志》2012年第13期2802-2804,共3页Chinese Journal of Nosocomiology

基　　金：广东省科技计划项目资助(2010B030700051)

摘　　要：目的分析肿瘤专科医院ICU侵袭性真菌性肺炎(IPFI)高危因素以及病原菌分布特点,指导临床治疗。方法采用回顾性调查方法,对肿瘤专科医院ICU179例肿瘤重症患者进行统计分析。结果肿瘤专科医院IPFI发生率为16.8%,广谱抗菌药物使用>10d、机械通气时间>2周以及骨髓抑制是此类患者发生IPFI的高危因数,OR值分别为11.039、6.024及6.811;30例IPFI病例中,细菌培养检出白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌和曲霉菌属,分别占80.0%、13.3%、3.3%及3.3%。结论有效治疗原发病,减少机械通气时间,纠正骨髓抑制,避免滥用广谱抗菌药物可有效减少肿瘤患者IPFI的发生率;氟康唑及伏立康唑是IPFI经验治疗的首选。OBJECTIVE To investigate the risk factors of invasive pulmonary fungal infections（IPFI） and the distribution of pathogenic bacteria in tumor hospital intensive care unit（ICU）.METHODS A total of 179 patients in tumor hospital ICU were investigated and analyzed statistically by retrospective studies.RESULTS The incidence of IPFI was 16.8%.The duration of mechanical ventilation more than two weeks,bone marrow suppression and the use of wide-spectrum antibiotics more than 10 days were the independent risk factors for IPFI,the values of OR were 6.024,6.811 and 11.039 respectively.The main pathogens causing IPFI in 30 patients were Candida albicans（80.0%）,C.glabrata（13.3%）,C.tropicalis（3.3%） and Aspergillus（3.3%）.CONCLUSION To effectively treat the primary disease,reduce the mechanical ventilation,promptly correct bone marrow suppression and avoid the misapplication of wide-spectrum antibiotics can effectively reduce the incidence of IPFI;fluconazol and voriconazole are the primary choice for the empirical treatment of IPFI.

关 键 词：肿瘤 侵袭性肺部真菌感染 危险因素 病原菌 

分 类 号：R181.32[医药卫生—流行病学]