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%，Plt;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 (Pgt;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（Pgt;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.
Objective To explore the risk factors of invasive fungal infection ( IFI) in respiratory ward. Methods A multi-center, retrospective, case-control study was carried out. Patients from five general hospitals in Chongqing city, diagnosed as fungal infection, or whose respiratory specimens were fungal positive, were retrospectively screened for IFI. Patients with respiratory infection and colonization of nonfungal cases in the same period of hospitalization were enrolled as control. Results Thirty-four patients diagnosed with IFI and 50 patients diagnosed with bacterial infection were analyzed for the risk factors of IFI. The demographic characteristics of patients including age and gender were not different( P gt; 0. 05) , but hospitalization days, carbapenem antibiotic use, chemotherapy, deep venous catheterization, total parenteralnutrition( TPN) , neutropenia, and renal disfunction were different significantly between the IFI group and the control group. Multiple logistic regression analysis showed that carbapenem antibiotic use ( OR = 6. 753) ,central venous catheterization ( OR = 5. 021) and TPN ( OR = 3. 199) were main risk factors of invasive fungal infection. Conclusion The carbapenem antibiotic use, central venous catheterization and TPN are risk factors for IFI in respiratory ward.
Objective To investigate whether de-escalation antibacterial therapy would be helpful to antifungal treatment in patients with invasive pulmonary fungal infection( IPFI) .Methods A prospective study was conducted in 174 IPFI patients( male 106, female 68) in the Second Hospital of Hebei Medical University from January 2008 to July 2010. The clinical data was collected including symptoms, physical signs,microbiological results, treatment and prognosis, etc. The therapeutic results were compared between the patients who received or did not receive de-escalation antibacterial therapy. Results The predominant pathogenic fungus was Candida albicans, which accounted for 59. 7% of IPFI. The effect of antifungal therapy showed statistically significant difference between the patients who received de-escalation antibacterial therapy and the patients who did not ( 60. 0% vs. 34. 5% , P =0. 001) . Conclusion The deescalation use of antibacterial therapy would be helpful to antifungal efficacy.
Objective To summarize the clinical features, predisposing factors, diagnosis, therapeutic outcome, and prognosis of invasive pulmonary fungal infection( IPFI) . Methods 90 cases with pathologically proved IPFI, admitted in non-intensive care unit in Xiangya Hospital from January 2005 to February 2012, were retrospectively analyzed. Results The pathogenic examination revealed Aspergillosis in 56 cases( 62. 2% ) , Cryptococcus in 18 cases( 20. 0% ) , Mucormycosis in 6 cases( 6. 7% ) , and Histoplasma in 6 cases( 6. 7% ) , etc. The underlying diseases were reported in 87 cases, and mainly included COPD, pulmonary tuberculosis, and diabetes mellitus. Cough and expectoration were the common clinical symptoms. 49 patients ( 54. 4% ) received long-term and broad-spectrum antibiotic therapy. The CT results revealed masses type in 25 cases( 27. 8%) , nodule lesions type in 15 cases( 16. 7% ) , lung consolidation type in 22 cases( 24. 4% ) , cavity type in 22 cases( 24. 4% ) , aspergilloma type in 6 cases( 6. 7% ) . 47 patients were clinical diagnosed with IPFI before biopsy with preliminary diagnosis accordance rate of 52. 2% . 31 cases ( 34. 4% ) underwent surgical resection of pulmonary lesions, and no recurrence was detected over two-year follow up. 56 cases ( 62. 2% ) received systemic anti-fugal therapy, and 43 cases( 76. 8% ) were cured or significantly improved. 3 cases ( 3. 3% ) refused any therapy. Conclusions The most frequently isolated pathogen of IPFI is Aspergillosis. The mainly underlying diseases are COPD, pulmonary tuberculosis, and diabetes mellitus. Long-termand broad-spectrum antibiotic therapy may be the major risk factor. Pathological examination is needed for final diagnosis. Surgical procedure can achieve optimal prognosis.
【摘要】 目的 总结慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD） 患者院外用药情况，并分析其院外用药情况、痰真菌检出率以及激素不良反应发生率的变化。 方法 调查2011年1-6月住院的161 例COPD 患者院外用药情况，将其分为遵医嘱使用糖皮质激素组（A组，包括口服和吸入激素）、使用非准字号药物组（B组）和未使用以上两种药物组（C组），对各组的痰真菌检出率进行统计学分析，并对A、B组激素不良反应的发生率进行分析。再将现阶段的调查结果与2006年同样研究结果进行比较。 结果 161例患者中使用口服糖皮质激素6例，使用吸入激素29例，使用非准字号药物32例，未使用以上两种药物94例。痰真菌检出率情况:B组检出率为62.5%，明显高于A组的17.14%、C组的27.66%；组间比较有统计学意义（Plt;0.001）。B组的药物不良反应发生率为37.5%；A组中口服激素发生率为50%，而使用吸入激素发生率为0%。与2006年同样研究结果比较，B组患者的比例明显下降，A组患者明显增多。 结论 使用非准字号药物的患者，真菌感染的危险性及激素不良反应的发生率较高，健康教育对于减少这些不良现象的发生发挥了重要作用。【Abstract】 Objective To investigate the use of drugs in patients with chronic obstructive pulmonary disease (COPD) outside the hospital, and analyze the detection rate of fungus and the side effects of glucocorticosteroids (GCs), and their changes. Methods We investigated the drugs used outside the hospital in 161 patients with stable COPD between January and June 2011, who were divided into prescribed medication GCs group (group A, including oral GCs group and inhaled GCs group), drugs without authorization by SFDA (DWAS) group (group B) and other drugs group (group C). Then we made a statistical analysis on the detection rate of fungus, and the incidence rate of the side effects of GCs in the three groups. Finally we compared the present findings with the similar studies five years ago. Results Among the 161 patients, 6 took oral GCs, 29 used inhaled GCs, 32 used DWAS, and 94 used other drugs. The detection rate of fungus in group B was 62.5%, obviously higher than the other groups (17.14% in group A, and 27.66% in group B, Plt;0.05). The rate of side effects of GCs in group B was 37.5%, and 50% in oral GCs group, while no side effects of GCs was found in the inhaled GCs group. Compared with the similar study five years ago, the use of DWAS decreased, and the use of prescribed medication GCs among the patients increased significantly. Conclusions Patients taking DWAS have a high incidence rate of mycotic infection and side effects of GCs. Health education plays an important role in reducing the occurrences of these undesirable phenomena.
【摘要】 目的 探讨老年慢性阻塞性肺疾病(COPD)患者院内肺部真菌感染的可能易患因素、感染时间、临床特征、感染常见真菌与预后。 方法 回顾性分析36例65岁以上COPD 院内肺部真菌感染患者与同期40例65岁以上COPD院内肺部非真菌感染患者的临床资料。 结果 老年COPD患者院内肺部真菌感染的可能易患因素与长期使用广谱抗生素、糖皮质激素,低蛋白血症、粒细胞减少相关;吸烟时间较长及每年住院次数增多也是老年COPD患者发生院内肺部真菌感染的可能易感因素;约1/3患者肺部真菌发生在入院1~2周,临床特征无特异性;病原菌主要为白色念珠菌(8055%),胸部X线表现以支气管肺炎及团块影改变为主,预后较差。 结论 老年COPD患者若长期使用广谱抗生素和(或)糖皮质激素,有低蛋白血症或粒细胞减少,可能会并发院内肺部真菌感染,预后较差,长期吸烟及多次住院患者也应提高警惕,重视可能易患因素并尽早采取预防与治疗措施,减少死亡的发生。【Abstract】 Objective To investigate the possible risk factors of nosocomial pulmonary fungal infection, infection time, the clinical features, common infection fungal and prognosis of elderly patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 36 patient of COPD complicated with nosocomial pulmonary fungal infection over 65 years old and 40 patients without nosocomial pulmonary fungal infection were retrospectively analyzed. Results Longterm use of broadspectrum antibiotics and (or) glucocorticoid, hypoalbuminemia, neutropenia, smoking for a long time, and hospitalizations were risk factors for nosocomial pulmonary fungal infection in elderly COPD patients. In about 1/3 of patients, nosocomial pulmonary fungal infection occurred within one to two weeks of hospitalization. The clinical features were nonspecific. Pathogens were mainly Candida albicans (8055%). Bronchial pneumonia and group block were the main findings in Chest Xray. The prognosis was poor. Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia, neutropenia or use longterm broadspectrum antibiotics and (or) glucocorticoids.
Objective To evaluate the predicted value of APACHEⅡ score at admission for deep fungal infection（DFI） in patients with severe acute pancreatitis （SAP）.Methods The clinical data of 132 patients with SAP from January 2006 to June 2011 in our hospital were analyzed retrospectively. The receiver operating characteristic curve （ROC） was used for evaluating the predicted value.Results Thirty-nine patients with SAP infected DFI （29.5%）,of which 36 patients （92.3%） infected with Candida albicans,2 patients （5.1%） with Candida tropicalis,1 patient （2.6%） with pearl bacteria.And,among these 39 patients,27 patients （69.2%） infected at single site,12 patients （30.8%） infected at multi-site. The APACHEⅡ score in 39 patients with DFI was higher than that of 93 patients without DFI （17.1±3.8 versus 9.7±2.1, t=14.316,P=0.000）.The ROC for APACHEⅡ score predicting DFI was 0.745（P=0.000）, 95%CI was 0.641－0.849.When the cut off point was 15,it showed the best forecast performance,with specificity 0.81, sensitivity 0.72,Youden index 0.53. Conclusions The APACHEⅡ score at admission can preferably predict DFI in patients with SAP； when the APACHEⅡ score is greater than 15,it prompts highly possible of DFI,so preventive anti-fungal treatment may be necessary.
【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation． MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%， and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula， biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.
Objective To analyze the risk factors associated with fungal infections in adult recipients after living donor liver transplantation (LDLT). Methods Data of 189 recipients from January 2006 to December 2012 who received LDLT at our center were retrospectively analyzed. Cox regression analysis was used to analyze the risk factors for postoperative fungal infections. Results Postoperative fungal infection was found in 12 recipients. The most common infectious site was lung, whereas the most common fungal pathogen was Candida albicans. Multivariate analysis suggested preoperative low albumin level [HR=0.792, 95%CI (0.694, 0.903), P=0.001], massive intraoperative red blood cell transfusion [HR=4.322, 95%CI (1.308, 14.277), P=0.016] and longer postoperative intensive care unit (ICU) stay [HR=3.399, 95%CI (1.004, 11.506), P=0.049] were the independent risk factors for postoperative fungal infections. Conclusions Lung is the most common fungal infection site after LDLT. Preoperative low albumin level, massive intraoperative red blood cell transfusion and longer postoperative ICU contribute to fungal infections after LDLT.