Clinical analysis of 47 cases of nosocomial pulmonary fungal infection in respiratory intensive care unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WU Ning ¹ ,  HUANG Yi ¹ , LI Qiang ¹ , YANG Yubo ² , SHAO Xiaoguang ³ , LI Haiyan ⁴

Department of Respiratory Medicine，Changhai Hospital，Second Military Medical University.Shanghai，200433，China Corresponding author：HUANG Yi，E-mail：huangliur@163.com;

Corresponding author：

HUANG Yi, Email: huangliur@163.com

Keywords：

Pneumonia; Fungal infections; Nosocomial infections; Intensive care unit

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Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，P lt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (P gt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（P gt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.

Citation： WU Ning,HUANG Yi,LI Qiang,YANG Yubo,SHAO Xiaoguang,LI Haiyan. Clinical analysis of 47 cases of nosocomial pulmonary fungal infection in respiratory intensive care unit. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(3): 182-186. doi: Copy

1.	Kam LW，Lin JD.Management of systemic candidal infections in the intensive care unit.Am J Health Syst Pharm，2002，59：33-41.
2.	Vincent JL，Chierego M，Struelens M，et al.Infection control in the intensive care unit.Expert Rev Anti Infect Ther，2004，2：795-805.
3.	中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则(草案).中华内科杂志，2006，45：697-700.
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5.	刘正印，盛瑞媛，李旭丽，等.院内真菌感染149例分析.中华医学杂志，2003，83：399-402.
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7.	Dimopoulos G，Piagnerelli M，Berre J，et al.Disseminated aspergillosis in intensive care unit patients：an autopsy study.J Chemother，2003，15：71-75.
8.	José Garnacho-Montero，Rosario Amaya-Villar，Carlos Ortiz-Leyba，et al.Isolation of Aspergillus spp.from the respiratory tract in critically ill patients：risk factors，clinical presentation and outcome.Critical Care，2005，9：191-199.
9.	Nina Singh，David L.Paterson.Aspergillus Infections in Transplant Recipients.Clin Microbiol Rev，2005，18：44-69.
10.	Pierre Emmanuel Charles，Frdric Dalle，Herv Aube，et al.Candida spp.colonization significance in critically ill medical patients：a prospective study.Intensive Care Med，2005，31：393-400.
11.	Richardson MD.Changing patterns and trends in systemic fungal infections.J Antimicrob Chemother，2005，56（Suppl1）：5-11.
12.	Khasawneh F，Mohamad T，Moughrabieh MK，et al.Isolation of Aspergillus in critically ill patients：a potential marker of poor outcome.J Crit Care，2006，21：322-327.
13.	Wisplinghoff H，Bischoff T，Tallent SM，et al.Nosocomial bloodstream infections in US hospitals：analysis of 24，179 cases from a prospective nationwide surveillance study.Clin Infect Dis，2004，39：309-317.
14.	Kontoyiannis DP，Bodey GP.Invasive aspergillosis in 2002：an update.Eur J Clin Microbiol Infect Dis，2002，21：161-172.
15.	Vandewoude KH，Vogelaers D，Blot SI.Aspergillosis in the ICU - The new 21st century problem? Med Mycol，2006，44 Suppl：71-76.
16.	缪竞智.老年人肺部真菌感染的诊断与治疗.中华老年医学杂志，2005，24：329-331.
17.	Piarroux R，Grenouillet F，Balvay P，et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med，2004，32：2443-2449.
18.	Ostrosky-Zeichner L.Novel approaches to antifungal prophylaxis.Expert Opin Investig Drugs，2004，13：665-672.
19.	Ibanez-Nolla J，Nolla-Salas M，Leon MA，et al.Early diagnosis of candidiasis in non-neutropenic critically ill patients.J Infect，2004，48：181-92.

1. Kam LW，Lin JD.Management of systemic candidal infections in the intensive care unit.Am J Health Syst Pharm，2002，59：33-41.
2. Vincent JL，Chierego M，Struelens M，et al.Infection control in the intensive care unit.Expert Rev Anti Infect Ther，2004，2：795-805.
3. 中华内科杂志编辑委员会.侵袭性肺部真菌感染的诊断标准与治疗原则(草案).中华内科杂志，2006，45：697-700.
4. 马军.侵袭性真菌感染的流行病学.中华医学杂志，2005，85：1443-1444.
5. 刘正印，盛瑞媛，李旭丽，等.院内真菌感染149例分析.中华医学杂志，2003，83：399-402.
6. Muquim A，Dial S，Menzies D.Invasive aspergillosis in patients with chronic obstructive pulmonary diseases.Can Respir J，2005，12：199-204.
7. Dimopoulos G，Piagnerelli M，Berre J，et al.Disseminated aspergillosis in intensive care unit patients：an autopsy study.J Chemother，2003，15：71-75.
8. José Garnacho-Montero，Rosario Amaya-Villar，Carlos Ortiz-Leyba，et al.Isolation of Aspergillus spp.from the respiratory tract in critically ill patients：risk factors，clinical presentation and outcome.Critical Care，2005，9：191-199.
9. Nina Singh，David L.Paterson.Aspergillus Infections in Transplant Recipients.Clin Microbiol Rev，2005，18：44-69.
10. Pierre Emmanuel Charles，Frdric Dalle，Herv Aube，et al.Candida spp.colonization significance in critically ill medical patients：a prospective study.Intensive Care Med，2005，31：393-400.
11. Richardson MD.Changing patterns and trends in systemic fungal infections.J Antimicrob Chemother，2005，56（Suppl1）：5-11.
12. Khasawneh F，Mohamad T，Moughrabieh MK，et al.Isolation of Aspergillus in critically ill patients：a potential marker of poor outcome.J Crit Care，2006，21：322-327.
13. Wisplinghoff H，Bischoff T，Tallent SM，et al.Nosocomial bloodstream infections in US hospitals：analysis of 24，179 cases from a prospective nationwide surveillance study.Clin Infect Dis，2004，39：309-317.
14. Kontoyiannis DP，Bodey GP.Invasive aspergillosis in 2002：an update.Eur J Clin Microbiol Infect Dis，2002，21：161-172.
15. Vandewoude KH，Vogelaers D，Blot SI.Aspergillosis in the ICU - The new 21st century problem? Med Mycol，2006，44 Suppl：71-76.
16. 缪竞智.老年人肺部真菌感染的诊断与治疗.中华老年医学杂志，2005，24：329-331.
17. Piarroux R，Grenouillet F，Balvay P，et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med，2004，32：2443-2449.
18. Ostrosky-Zeichner L.Novel approaches to antifungal prophylaxis.Expert Opin Investig Drugs，2004，13：665-672.
19. Ibanez-Nolla J，Nolla-Salas M，Leon MA，et al.Early diagnosis of candidiasis in non-neutropenic critically ill patients.J Infect，2004，48：181-92.

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Clinical analysis of 47 cases of nosocomial pulmonary fungal infection in respiratory intensive care unit

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