侵袭性真菌病111例临床特点及体外药敏分析  

Clinical feature and antifungal susceptibility analysis of 111 cases of invasive fungal disease

作　　者：唐晓丹[1] 吴菊芳[2] 章强强[1] 徐俊芳[2] 陈轶坚[2] 

机构地区：[1]复旦大学附属华东医院呼吸科,上海200040 [2]复旦大学附属华山医院

出　　处：《中国感染与化疗杂志》2013年第6期420-427,共8页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解侵袭性真菌病111例的病原菌分布及临床特点,为临床及实验室侵袭性真菌病的诊治提供参考资料。方法回顾性分析复旦大学附属华山医院2004年1月—2006年12月血液、正常无菌体液(包括脑脊液、胸水、腹水、胆汁、关节腔积液等)、深部脏器组织(包括肺、肝、脑等)中真菌培养或镜检阳性的病例,以及自痰、支气管肺泡灌洗液曲霉或隐球菌培养阳性的病例,根据诊断标准对其中确诊及拟诊的侵袭性真菌病进行分析。结果本研究共入选侵袭性真菌病病例111例。其中确诊(proven)104例,拟诊(probable)7例。属社区获得性感染61例,医院感染50例。感染部位以血流最常见,51例(45.9%),其次为中枢神经系统44例(39.6%)、肺部感染14例(12.6%)。病原真菌以念珠菌属最常见,50株(45.0%),其次为隐球菌47株(42.3%)、曲霉12株(10.8%)。社区获得性真菌病61例,主要为中枢神经系统44例(72.1%)和肺部12例(19.7%)。社区获得性感染中占优势的真菌为隐球菌47例(77.0%)、曲霉10株(16.4%)。医院感染真菌病50例,最常见为血流感染48例(96.0%),病原真菌以念珠菌属最为常见,47株(94.0%),其中又以白念珠菌占多数。多数医院感染患者都存在基础疾病和多种诱发因素。其中深静脉置管与医院血流感染的关系密切,64.7%念珠菌性血流感染患者深静脉置管超过1周,且11例患者静脉留置管与血培养呈相同的菌种。而社区获得性真菌病中超过一半患者无明确的基础疾病和诱发因素。本组病例病死率为14.4%(16例)。其中医院感染侵袭性真菌病病死率18.0%(9/50),高于社区获得性侵袭性真菌病病死率11.5%(7/61)。不同真菌病的病死率以曲霉为最高(33.3%)。结论侵袭性真菌病中以血流感染、中枢神经系统感染及肺部感染为常见。病原真菌依次为念珠菌、隐球菌和曲霉。社区获得性真菌病以隐球菌脑膜炎最多见。医院感染则以念珠�Objective To describe the clinical features of invasive fungal disease in Huashan Hospital, Fudan University from January 2004 to December 2006. Methods The medical data were reviewed retrospectively for the patients with fungal infection, which was confirmed by positive fungal culture or microscopic examination with blood, sterile body fluid, deep tissue, sputum specimen or isolation of Aspergillus spp. and Cryptococcus spp. from bronchoalveolar lavage. The proven and probable cases of invasive fungal disease were included in this analysis. Results A total of 111 patients were diagnosed as invasive fungal dis- ease, including 104 proven cases and 7 probable cases. Sixty-one cases were community-acquired and the other 50 were nosoeo- mial. The most common site of infection was bloodstream （51, 45.9%）, followed by central nervous system （44, 39.6%） and respiratory system （14, 12.6%）. The most common pathogens were Candida spp. （50, 45%）, Cryptococcus （47, 42.3%） and Aspergillus spp. （12, 10. 8%）. The community acquired fungal infections were mostly found in central nervous system （44,72. 1%）, and respiratory system （12, 19.7%）, mainly caused by Cryptococcus and Aspergillus. The nosocomial fungal infections occurred primarily in blood-stream （96.0%）, mainly due to Candida spp. No underlying disease or risk factor was identified in more than half of the pa- tients with community-acquired infection, while almost all the patients with nosocomial fungal infection had underlying disease and predisposing factors. Indwelling venous catheter was closely associated with nosocomial bloodstream infection. Indwelling venous catheter lasted for more than 1 week in 64.7% of the patients with Candida bloodstream infection. The same fungal strain was isolated from both the cather and blood of the same patient in 11 cases. The overall mortality of these invasive fungal diseases was 14.4 % （16/111）. The mortality rate was 18.0 % （9/50） in the patients with nosocomial invasive fungal infect

关 键 词：侵袭性真菌病 临床特点 药敏试验 

分 类 号：R519[医药卫生—内科学]