Advances in the clinical research of invasive fungal infection in the intensive care unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Shengmin ,  ZHU Guangfa , LIANG Ying

Corresponding author：

ZHU Guangfa, Email: guangfa_zhu@yahoo.com

Keywords：

重症加强治疗病房; 真菌; 感染

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侵袭性真菌感染(IFI)不仅可发生在恶性血液病、恶性肿瘤、器官移植和AIDS等经典免疫功能缺陷患者中，近年来ICU的重症患者由于严重的基础疾病、外科手术指征和范围的扩大、各种导管的体内介入与留置，以及广谱抗生素和糖皮质激素的广泛应用等，IFI发病率也迅速增加。据统计，IFI占医院获得性感染的8％-15％。IFI病情进展快速、凶险，已13益成为导致ICU危重病患者死亡的重要原因之一。引起ICU IFI的病原体包括念珠菌、曲霉、隐球菌、镰刀霉、接合菌、肺孢子菌等，其中以念珠菌和曲霉最多见，占90％以上。由于ICU危重症患者多数属非经典IFI高危人群，临床表现缺乏特异性，临床诊治极为困难。本文就ICU内侵袭性念珠菌感染(Ic)和侵袭性曲霉感染(IA)的流行病学、诊断和治疗进展进行阐述，以期对临床有所裨益。

Citation： LIU Shengmin ,ZHU Guangfa,LIANG Ying. Advances in the clinical research of invasive fungal infection in the intensive care unit. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(6): 477-480. doi: Copy

1.	Ostrosky-Zeichner L，Pappas PG.Invasive candidiasis in the intensive care unit.Crit Care Med，2006，34：857-863.
2.	Meersseman W，Lagrou K，Maertens J，et al.Invasive aspergillosis in the intensive care unit.Clin Infect Dis，2007，45：205-216.
3.	Vallés J，Mesalles E，Mariscal D，et al.A 7-year study of severe hospital-acquired pneumonia requiring ICU admission.Intensive Care Med，2003，29：1981-1988.
4.	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.
5.	Lipsett PA.Surgical critical care：fungal infections in surgical patients.Crit Care Med，2006，34（9 Suppl）：S215-S224.
6.	Hajjeh RA，Sofair AN，Harrison LH，et al.Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program.J Clin Microbiol，2004，42：1519-1527.
7.	Pappas PG，Rex JH，Lee J，et al.A prospective observational study of candidemia：epidemiology，therapy，and influences on mortality in hospitalized adult and pediatric patients.Clin Infect Dis，2003，37：634-643.
8.	De Waele JJ，Vogelaers D，Blot S，et al.Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy.Clin Infect Dis，2003，37：208-213.
9.	Almirante B，Rodríguez D，Cuenca-Estrella M，et al.Epidemiology，risk factors，and prognosis of Candida parapsilosis bloodstream infections：case-control population-based surveillance study of patients in Barcelona，Spain，from 2002 to 2003.J Clin Microbiol，2006，44：1681-1685.
10.	Benjamin DK Jr，Garges H，Steinbach WJ.Candida bloodstream infection in neonates.Semin Perinatol，2003，27：375-383.
11.	Perfect JR，Cox GM，Lee JY，et al.The impact of culture isolation of Aspergillus species：a hospital-based survey of aspergillosis.Clin Infect Dis，2001，33：1824-1833.
12.	Segal BH，Walsh TJ.Current approaches to diagnosis and treatment of invasive aspergillosis.Am J Respir Crit Care Med，2006，173：707-717.
13.	Patterson TF.Advances and challenges in management of invasive mycoses.Lancet，2005，366：1013-1025.
14.	朱小敏，周新.侵袭性肺曲霉病的诊断与治疗.中国呼吸与危重监护杂志，2005，4：316-320.
15.	Meersseman W，Wingaerden EV.Invasive aspergillosis in the ICU：an emerging disease.Intensive Care Med，2007，33：1679-1681.
16.	Meersseman W，Vandecasteele SJ，Wilmer A，et al.Invasive aspergillosis in critically ill patients without malignancy.Am J Respir Crit Care Med，2004，170：621-625.
17.	曹彬，蔡柏蔷，王辉，等.肺部真菌感染152例病原谱再评价.中华结核和呼吸杂志，2007，30：279-283.
18.	Hartemink KJ，Paul MA，Spijkstra JJ，et al.Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med，2003，29：2068-2071.
19.	Ascioglu S，Rex H，de Pauw B，et al.Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants：An International Consensus.Clin Infect Dis，2002，34：7-14.
20.	中华内科杂志编辑委员会.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则.中华内科杂志，2005，44：554-556.
21.	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，2005，45：697-700.
22.	中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南.中华内科杂志，2007，46：960-966.
23.	Vandewoude KH，Vogelaers D.Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.Clin Infect Dis，2007，44：380-381.
24.	Bulpa P，Dive A，Sibille Y.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.Eur Respir J，2007，30：782-800.
25.	Ostrosky-Zeichner L，Rex JH，Bennett J，et al.Deeply invasive candidiasis.Infect Dis Clin North Am，2002，16：821-835.
26.	Hope WW，Walsh TJ，Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis，2005，5：609-22.
27.	Charles PE，Dalle F，Aube H，et al.Candida spp.colonization significance in critically ill medical patients：a prospective study.Intensive Care Med，2005，31：393-400.
28.	Bouza E，Guinea J，Peláez T，et al.Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.J Clin Microbiol，2005，43：2075-2079.
29.	Pazos C，Ponto J，DelPalacio A.Contributionof（1，3）-beta-D-glucan chromogenic assay to diagnosisand therapeutic monitoring of invasive aspergillosis in neutropenic adult patients：a comparison with serial screening for circulating galactomannan.J Clinic Microbiol，2005，43：299-305.
30.	Odabasi Z，Mattiuzzi G，Estey E，et al.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections：Validation，cutoff development，and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome.Clin Infect Dis，2004，39：199-205.
31.	吕沛华，赵蓓蕾，施毅，等.1，3-β-D葡聚糖检测诊断侵袭性真菌感染的临床价值.中华结核和呼吸杂志，2007，30：31-34.
32.	Pfeiffer CD，Fine JP，Safdar N.Diagnosis of invasive aspergillosis using a galactomannan assay：a meta-analysis.Clin Infect Dis，2006，15，42：1417-1427.
33.	朱小敏，周新，蔡逸婷，等.血清半乳甘露聚糖检测对器官移植术后侵袭性肺曲霉病的诊断价值.中国抗感染与化疗杂志，2005，5：209-211.
34.	Meersseman W，Lagrou K，Maertens J，et al.Galactomannan in Bronchoalveolar Lavage Fluid：A Tool for Diagnosing Aspergillosis in Intensive Care Unit Patients.Am J Respir Crit Care Med，2008，177：27-34.
35.	Edwards JE Jr，Bodey GP，Bowden RA，et al.International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections.Clin Infect Dis，1997，25：43-59.
36.	Piarroux R，Grenouillet P，Balvay V，et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med，2004，32：2443-2449.
37.	Pappas PG，Rex JH，Sobel JD，et al.Guidelines for treatment of candidiasis.Clin Infect Dis，2004，38：161-189.
38.	Herbrecht R，Denning DW，Patterson TF，et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.N Engl J Med，2002，347：408-415.

1. Ostrosky-Zeichner L，Pappas PG.Invasive candidiasis in the intensive care unit.Crit Care Med，2006，34：857-863.
2. Meersseman W，Lagrou K，Maertens J，et al.Invasive aspergillosis in the intensive care unit.Clin Infect Dis，2007，45：205-216.
3. Vallés J，Mesalles E，Mariscal D，et al.A 7-year study of severe hospital-acquired pneumonia requiring ICU admission.Intensive Care Med，2003，29：1981-1988.
4. 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.
5. Lipsett PA.Surgical critical care：fungal infections in surgical patients.Crit Care Med，2006，34（9 Suppl）：S215-S224.
6. Hajjeh RA，Sofair AN，Harrison LH，et al.Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program.J Clin Microbiol，2004，42：1519-1527.
7. Pappas PG，Rex JH，Lee J，et al.A prospective observational study of candidemia：epidemiology，therapy，and influences on mortality in hospitalized adult and pediatric patients.Clin Infect Dis，2003，37：634-643.
8. De Waele JJ，Vogelaers D，Blot S，et al.Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy.Clin Infect Dis，2003，37：208-213.
9. Almirante B，Rodríguez D，Cuenca-Estrella M，et al.Epidemiology，risk factors，and prognosis of Candida parapsilosis bloodstream infections：case-control population-based surveillance study of patients in Barcelona，Spain，from 2002 to 2003.J Clin Microbiol，2006，44：1681-1685.
10. Benjamin DK Jr，Garges H，Steinbach WJ.Candida bloodstream infection in neonates.Semin Perinatol，2003，27：375-383.
11. Perfect JR，Cox GM，Lee JY，et al.The impact of culture isolation of Aspergillus species：a hospital-based survey of aspergillosis.Clin Infect Dis，2001，33：1824-1833.
12. Segal BH，Walsh TJ.Current approaches to diagnosis and treatment of invasive aspergillosis.Am J Respir Crit Care Med，2006，173：707-717.
13. Patterson TF.Advances and challenges in management of invasive mycoses.Lancet，2005，366：1013-1025.
14. 朱小敏，周新.侵袭性肺曲霉病的诊断与治疗.中国呼吸与危重监护杂志，2005，4：316-320.
15. Meersseman W，Wingaerden EV.Invasive aspergillosis in the ICU：an emerging disease.Intensive Care Med，2007，33：1679-1681.
16. Meersseman W，Vandecasteele SJ，Wilmer A，et al.Invasive aspergillosis in critically ill patients without malignancy.Am J Respir Crit Care Med，2004，170：621-625.
17. 曹彬，蔡柏蔷，王辉，等.肺部真菌感染152例病原谱再评价.中华结核和呼吸杂志，2007，30：279-283.
18. Hartemink KJ，Paul MA，Spijkstra JJ，et al.Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med，2003，29：2068-2071.
19. Ascioglu S，Rex H，de Pauw B，et al.Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants：An International Consensus.Clin Infect Dis，2002，34：7-14.
20. 中华内科杂志编辑委员会.血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则.中华内科杂志，2005，44：554-556.
21. 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，2005，45：697-700.
22. 中华医学会重症医学分会.重症患者侵袭性真菌感染诊断与治疗指南.中华内科杂志，2007，46：960-966.
23. Vandewoude KH，Vogelaers D.Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.Clin Infect Dis，2007，44：380-381.
24. Bulpa P，Dive A，Sibille Y.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.Eur Respir J，2007，30：782-800.
25. Ostrosky-Zeichner L，Rex JH，Bennett J，et al.Deeply invasive candidiasis.Infect Dis Clin North Am，2002，16：821-835.
26. Hope WW，Walsh TJ，Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis，2005，5：609-22.
27. Charles PE，Dalle F，Aube H，et al.Candida spp.colonization significance in critically ill medical patients：a prospective study.Intensive Care Med，2005，31：393-400.
28. Bouza E，Guinea J，Peláez T，et al.Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.J Clin Microbiol，2005，43：2075-2079.
29. Pazos C，Ponto J，DelPalacio A.Contributionof（1，3）-beta-D-glucan chromogenic assay to diagnosisand therapeutic monitoring of invasive aspergillosis in neutropenic adult patients：a comparison with serial screening for circulating galactomannan.J Clinic Microbiol，2005，43：299-305.
30. Odabasi Z，Mattiuzzi G，Estey E，et al.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections：Validation，cutoff development，and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome.Clin Infect Dis，2004，39：199-205.
31. 吕沛华，赵蓓蕾，施毅，等.1，3-β-D葡聚糖检测诊断侵袭性真菌感染的临床价值.中华结核和呼吸杂志，2007，30：31-34.
32. Pfeiffer CD，Fine JP，Safdar N.Diagnosis of invasive aspergillosis using a galactomannan assay：a meta-analysis.Clin Infect Dis，2006，15，42：1417-1427.
33. 朱小敏，周新，蔡逸婷，等.血清半乳甘露聚糖检测对器官移植术后侵袭性肺曲霉病的诊断价值.中国抗感染与化疗杂志，2005，5：209-211.
34. Meersseman W，Lagrou K，Maertens J，et al.Galactomannan in Bronchoalveolar Lavage Fluid：A Tool for Diagnosing Aspergillosis in Intensive Care Unit Patients.Am J Respir Crit Care Med，2008，177：27-34.
35. Edwards JE Jr，Bodey GP，Bowden RA，et al.International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections.Clin Infect Dis，1997，25：43-59.
36. Piarroux R，Grenouillet P，Balvay V，et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med，2004，32：2443-2449.
37. Pappas PG，Rex JH，Sobel JD，et al.Guidelines for treatment of candidiasis.Clin Infect Dis，2004，38：161-189.
38. Herbrecht R，Denning DW，Patterson TF，et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.N Engl J Med，2002，347：408-415.

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