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.
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.
目的：探討慢性非侵襲性真菌性鼻竇炎(NIFS)的治療要點。方法：分析11 例NIFS 患者，全部施行鼻內鏡手術，術后定期隨訪。結果：術后隨訪2年，全部治愈。結論：以鼻內鏡手術治療為主的綜合治療，療效好，復發率低。
侵襲性真菌感染(IFI)不僅可發生在惡性血液病、惡性腫瘤、器官移植和AIDS等經典免疫功能缺陷患者中，近年來ICU的重癥患者由于嚴重的基礎疾病、外科手術指征和范圍的擴大、各種導管的體內介入與留置，以及廣譜抗生素和糖皮質激素的廣泛應用等，IFI發病率也迅速增加。據統計，IFI占醫院獲得性感染的8％-15％。IFI病情進展快速、兇險，已13益成為導致ICU危重病患者死亡的重要原因之一。引起ICU IFI的病原體包括念珠菌、曲霉、隱球菌、鐮刀霉、接合菌、肺孢子菌等，其中以念珠菌和曲霉最多見，占90％ 以上。由于ICU危重癥患者多數屬非經典IFI高危人群，臨床表現缺乏特異性，臨床診治極為困難。本文就ICU內侵襲性念珠菌感染(Ic)和侵襲性曲霉感染(IA)的流行病學、診斷和治療進展進行闡述，以期對臨床有所裨益。
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.
【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.
【摘要】 目的 對季也蒙念珠菌感染患者的臨床及微生物學特征進行分析，為臨床診治提供參考。 方法 收集2006年1月-2008年12月病原菌培養為季也蒙念珠菌的10例住院患者資料進行回顧性分析。 結果 季也蒙念珠菌感染患者存在多種基礎疾病，大多數患者（8/10）有易感因素，其中7例使用廣譜抗菌藥物。10例中有8例為深部真菌感染。其臨床表現與感染部位有關，主要累及泌尿道、呼吸道和皮膚軟組織。多數深部感染患者（6/8）在感染前存在同部位細菌感染，部分患者（3/8）在相同部位還可分離出其他真菌。全部季也蒙念珠菌菌株對兩性霉素B敏感，大多數菌株（9/10）對氟康唑敏感。僅1例患者因肺部感染、呼吸衰竭死亡，其余患者經氟康唑、伊曲康唑或特比萘芬等抗真菌藥物治愈。 結論 季也蒙念珠菌感染多發生于有基礎疾病、存在真菌易感因素者，感染部位多為原細菌感染部位，常合并其他細菌或真菌感染。部分菌株對氟康唑和伊曲康唑中敏或耐藥，治療應根據藥敏進行選擇。【Abstract】 Objective To analyze the clinical and microbiologic characters of candida guilliermondii to improve the clinical diagnosis and treatment. Methods The clinical data of 10 patients with candida guilliermondii infection diagnosed in our hospital from January 2006 to December 2008 were retrospectively analyzed. Results All the patients had several underlying conditions; eight patients had predisposing factors and seven patients were prescribed with broad-spectrum antibacterials. Eight patients had deep mycoses, whose clinical manifestation was associated with the infectious sites, mainly involved in urinary tract, respiratory tract and skin-soft tissues. Most deep mycoses (6/8) had prior bacterial infection at the candida guilliermondii infection site; some patients (3/8) had other fungous infection at the same time. All the strains were sensitive to amphotericin B; most fungous strains (9/10) were sensitive to fluconazole. One patient died of pulmonary infection and respiratory failure, and the others were cured by fluconazole, itraconazole or terbinafine. Conclusion Candida guilliermondii infection mainly occurs in patients with underlying conditions and predisposing factors. The infectious sites have prior bacterial infection and bacterial infection or fungous infection at the same time. Since some candida guilliermondii strains were not sensitive to fluconazole and itraconzole, drug sensitive test should be consulted.