老年危重患者深部真菌感染临床调查  

Clinical investigation of deep fungal infections in critical ill elderly patients

作　　者：黄虑[1] 张永信[1] 孙小丰[1] 张佳明[1] 房美娟[1] 

机构地区：[1]复旦大学附属华山医院,上海200040

出　　处：《中国抗生素杂志》2004年第3期163-165,共3页Chinese Journal of Antibiotics

摘　　要：目的　了解老年危重患者深部真菌感染的感染率与相关病死率 ,并分析感染相关危险因素。方法　采用回顾性调查研究的方法对 1999年 6月～ 2 0 0 1年 5月华山医院老年科 ICU的患者进行调查。结果　在调查的 2 4 7名患者中 ,有 32名患者发生深部真菌感染 ,感染率为 12 .96 % ;其中 ,18人死亡 ,相关病死率为 5 6 .2 5 % ,高于平均水平。最常见感染部位为肺部 (2 8例 ,87.5 % )。念珠菌是最常见的感染菌种 ,尤其是白念珠菌 (31株 ,72 .0 9% )。在单因素分析中 ,入住 ICU时间 (P=0 .0 0 0 )、使用广谱抗生素种类数 (P=0 .0 18)、合并严重细菌感染 (P=0 .0 0 0 )、具有 COPD基础 (P=0 .0 14 )、气管插管 (P=0 .0 11)为发生深部真菌感染的危险因素 ;L ogistic多因素回归分析显示合并严重细菌感染及使用广谱抗生素为老年科 ICU深部真菌感染的独立危险因素。结论　老年科 ICU深部真菌感染发生率较高 ,预后差 ,应采取有效措施 ,控制各类危险因素 ,切实降低其发病率。Objective To investigate the morbidity and mortality of deep fungal infection in critical ill elderly patients,and analyse the risk factors. Method A retrospective study on all the patients in gerontism department ICU of Huashan hospital between June 1999 and May 2001 was conducted. Results Two hundred and forty-seven cases were investigated. Deep fungal infection were found in 32 cases (12.96%);among them,18 patients died. The mortality in deep fungal infections group was 56.25%,higher than the average. Lower respiratory tract infection was the commonest (28 cases,87.5%). Candida spp. was the major pathogens,especially Candida albicans (31 strains,72.09%). The days in ICU ( P =0.000),usage of broad-spectrum antibiotic ( P =0.018),critical bacterial infection ( P =0.000),COPD ( P =0.014),and tracheal cannula ( P =0.011) were significant risk factors. However,logistic regression analysis suggested that the combination of severe bacterial infections and use of broad-spectrum antibiotic was independent on incidence of deep fungal infections. Conclusions The morbidity of deep fungal infection in critical ill elderly patients was quite high,and the prognosis was gloomy. It is imperative to make efforts to reduce the morbidity of deep fungal infection in critical ill elderly patients.

关 键 词：老年患者 ICU 深部真菌感染 念珠菌 危险因素 

分 类 号：R519[医药卫生—内科学]