ICU深部真菌感染现状及对策.doc

ICU深部真菌感染现状及对策[摘要] 目的：了解ICU深部真菌感染的现状，探讨预防和治疗深部真菌感染的对策。方法：以医院感染诊断标准为依据诊断深部真菌感染，收集2003年1月~2006年12月送检的各类标本经真菌培养出的深部真菌，经TDR鉴定仪鉴定到种，运用Whonet 5.1软件进行数据分析处理。结果：分离出的真菌标本中，真菌感染阳性标本前4位分别是痰液、尿液、血液、大便。真菌阳性前5位的真菌菌种分别为白色念珠菌、近平滑念珠菌、热带念珠菌、光滑球念珠菌和克柔念珠菌。常见真菌对常见抗真菌药物的敏感性由高到底依次为两性霉素B、制霉菌素、益康唑、克霉唑、酮康唑、咪康唑、5-氟胞嘧啶、伊曲康唑、氟康唑、灰黄霉素。结论：深部真菌存在高感染率、低诊断率、低治疗率和高死亡率等特点，要重视预防并加强真菌感染的监测，早诊断，并根据深部真菌感染的可能性大小进行预防性治疗、抢先治疗、经验性治疗及目标性治疗等，改善深部真菌感染患者的预后。 [关键词] 真菌感染；诊断；治疗 [中图分类号]R563 [文献标识码]A [文章编号]1673-7210（2008）01（c）-098-03 The current situation issues and countermeasures of deep fungal infection in ICU ZHANG Sheng-an, WANG Sheng-biao, HUANG Qiang, CAI Ye-ping,CHEN Yi-fan (The First Hospital of Chenzhou, Chenzhou 42300,China) [Abstract] Objective: To evaluate the current situation of deep fungal infection in ICU, and to investigate the countermeasures for prevention and treatment of deep fungal infection in ICU. Methods: According to the diagnosis standard of nosocomial infections, we collected the fungi isolated from all kinds of samples and identified fungi strains by TDR. Results: Among all strains samples, fungi isolated from sputum, urine, blood and stool were much more than others. All strains of candida isolated from samples in ICU with more frequency included Candida albicans, Candidaparapsilosis, C.tropicalis, C.glabrate, C.krusei. Sensitivity results to ten antifungals showed that the frequent fungi were sensitive to Amphotericin B, Nystatin, Econazaole, Miconazole, Clotrimazole, Ketoconazole, Flucytosine, Itraconazole, Fluconazole and Griseofulvin. Conclusion: Deep fungi have higher infection rate, lower diagnosis rate, lower treatment rate and higher death rate. So we should strengthen the surveillance on susceptibility of clinical isolates fungi so as to diagnose early. And choose the antifugal agents to treat according to the probability of deep fungal infection, to improve the prognosis. [Key words] Fungal infection; Diagnosis; Treatment 我院ICU为大型综合性ICU，年收治患者超过1 000例，其集中