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Factors Associated with Fungal Infection Following Pancreatoduodenectomy

【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 noncondition Logistic regression analyse. Results①Seventyeight 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.

經纖維支氣管鏡診斷曲霉感染100例分析

目的探討纖維支氣管鏡檢查在肺曲霉感染診斷中的作用。 方法回顧性分析2012年至2014年我院100例曲霉感染患者的臨床資料及纖維支氣管鏡(簡稱纖支鏡)檢查結果。 結果100例曲霉感染患者中, 男65例, 女35例, 年齡12~85歲, 30歲以下患者15例。62例合并基礎疾病, 包括20例結核, 23例腫瘤, 6例慢性阻塞性肺疾病。36例患者經纖支鏡病理檢查確診, 其中4例經纖支鏡肺活檢確診, 無并發癥發生; 64例患者纖支鏡灌洗液或痰液曲霉培養陽性, 屬于臨床診斷。 結論纖支鏡病理檢查及灌洗液培養是診斷肺曲霉感染的有效手段, 若臨床情況允許, 應盡早進行纖支鏡檢查明確診斷。

Influence of De-escalation Antibacterial Therapy on Invasive Pulmonary Fungal Infection

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.

A nomogram for predicting secondary pulmonary fungal infection in patients with acute exacerbations of chronic obstructive pulmonary disease

Objective To investigate the risk factors for secondary pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). And a visual tool using nomogram was developed and validated to assist in the clinical prediction of the probability of pulmonary fungal infection occurrence in AECOPD patients. Methods A retrospective cohort study method was used to collect AECOPD patients hospitalized in the Department of Respiratory, The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2021 as a training set. And AECOPD patients between January 2020 and December 2020 were collected as a validation set. Independent risk factors were determined through univariate, Lasso regression analyses. and multivariable logistic, A nomogram prediction model was constructed with these independent risk factors, and the nomogram was evaluated by receiver operating characteristic area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Results The use of glucocorticoid, combined use of antibiotics, duration of antibiotic use and hypoalbuminemia were independent risk factors for secondary pulmonary fungal infection in AECOPD patients (all P<0.05). The training set and validation set of the constructed prediction model had an AUC value of 0.915 [95%CI: 0.891 - 0.940] and 0.830 [95%CI: 0.790 - 0.871], respectively. The calibration curve showed that the predicted probability was in good agreement with the actual observed probability of pulmonary fungal infection in AECOPD patients. The corresponding decision curve analysis (DCA) indicated the nomogram had relatively ideal clinical utility. Conclusions The result showed that the use of glucocorticoid, combined use of antibiotics, prolonged antibiotic therapy and hypoalbuminemia was independent risk factors for pulmonary fungal infection in AECOPD patients. The clinical prediction model for secondary pulmonary fungal infection in AECOPD patients constructed in this study has strong predictive power and clinical practicability.

Clinical Survey on Drug Use in Patients with Chronic Obstructive Pulmonary Disease Outside the Hospital

【摘要】　目的　總結慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD） 患者院外用藥情況，并分析其院外用藥情況、痰真菌檢出率以及激素不良反應發生率的變化。　方法　調查2011年1-6月住院的161 例COPD 患者院外用藥情況，將其分為遵醫囑使用糖皮質激素組（A組，包括口服和吸入激素）、使用非準字號藥物組（B組）和未使用以上兩種藥物組（C組），對各組的痰真菌檢出率進行統計學分析，并對A、B組激素不良反應的發生率進行分析。再將現階段的調查結果與2006年同樣研究結果進行比較。　結果　161例患者中使用口服糖皮質激素6例，使用吸入激素29例，使用非準字號藥物32例，未使用以上兩種藥物94例。痰真菌檢出率情況:B組檢出率為62.5%，明顯高于A組的17.14%、C組的27.66%；組間比較有統計學意義（Plt;0.001）。B組的藥物不良反應發生率為37.5%；A組中口服激素發生率為50%，而使用吸入激素發生率為0%。與2006年同樣研究結果比較，B組患者的比例明顯下降，A組患者明顯增多。　結論　使用非準字號藥物的患者，真菌感染的危險性及激素不良反應的發生率較高，健康教育對于減少這些不良現象的發生發揮了重要作用。【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.

合并侵襲性肺部真菌感染的支氣管中央性肉芽腫病一例

類風濕關節炎合并毛霉菌肺部感染一例

Low Dose MSCT Diagnosis of Pulmonary Fungal Infection

Objective To explore the diagnosis value of the low dose multi-slice spiral computed tomography (MSCT) imaging in pulmonary fungal infection in order to improve its diagnosis level. Methods CT manifestations of 106 cases of pulmonary fungal infection confirmed by operation, pathology, mycetes cultivation and follow-ups of clinical therapy were retrospectively analyzed. All cases underwent low dose MSCT examinations including CARE dose 4D and sinogram affirmed iterative reconstruction technology, and 6 cases underwent contrast-enhanced CT scanning. Results Among the basic MSCT findings of pulmonary fungal infection, they showed patch-nodular type in 54 cases, solid variant in 38 cases, and tumor type in 14 cases. In all cases, 91 cases displayed as mulifocality, 83 cases as polymorphism and 78 cases as polytropy. Among the 106 cases with comparative distinctive MSCT manifestations, bud of branch sign were showed in 39 cases, halo sign in 32 cases, wedge shape consolidation in 19 cases, ice needle sign in 15 cases, crescentic sign in 11 cases, air ring sign in 6 cases, and contra-halo sign in 4 cases. The nodules in the cavities were not enhanced in enhanced scan in 5 cases. Conclusions There are some distinctive MSCT findings in patients with pulmonary fungal infection. Pulmonary fungal infection can be diagnosed with typical MSCT findings in close combination with the clinical information.

Clinical Analysis of Elderly Patients with Chronic Obstructive Pulmonary Disease with Nosocomial Pulmonary Fungal Infection

【摘要】 目的 探討老年慢性阻塞性肺疾病(COPD)患者院內肺部真菌感染的可能易患因素、感染時間、臨床特征、感染常見真菌與預后。 方法 回顧性分析36例65歲以上COPD 院內肺部真菌感染患者與同期40例65歲以上COPD院內肺部非真菌感染患者的臨床資料。 結果 老年COPD患者院內肺部真菌感染的可能易患因素與長期使用廣譜抗生素、糖皮質激素,低蛋白血癥、粒細胞減少相關;吸煙時間較長及每年住院次數增多也是老年COPD患者發生院內肺部真菌感染的可能易感因素;約1/3患者肺部真菌發生在入院1~2周,臨床特征無特異性;病原菌主要為白色念珠菌(8055%),胸部X線表現以支氣管肺炎及團塊影改變為主,預后較差。 結論 老年COPD患者若長期使用廣譜抗生素和(或)糖皮質激素,有低蛋白血癥或粒細胞減少,可能會并發院內肺部真菌感染,預后較差,長期吸煙及多次住院患者也應提高警惕,重視可能易患因素并盡早采取預防與治療措施,減少死亡的發生。【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 Longterm use of broadspectrum 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 nonspecific. Pathogens were mainly Candida albicans (8055%). Bronchial pneumonia and group block were the main findings in Chest Xray. The prognosis was poor. Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia, neutropenia or use longterm broadspectrum antibiotics and (or) glucocorticoids.

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

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.