重症患者真菌感染聚焦念珠菌及氟康唑的地位广西北海M.pptVIP

A total of 96060 ICU patients from 67 centres throughout China were screened. Of these, 306 (0.32% or 3.2 per 1000 ICU admissions) were diagnosed with ICI. The majority of patients (62.1%) were transferred to the ICU from another department within the same hospital. The median time between hospital admission and con?rmed diagnosis of ICI was 15.5 days (range: 0–1611 days) and between ICU admission and diagnosis was 10.0 days (0–330 days); 80.7% of ICI cases occurred .48 h after ICU admission. 中国16家大型教学医院HAP临床调查 注意：这里的比例数值是指占总共病原菌的数值（包括阳性、真菌） 而CHINET/Mohnarin 里的值是指 占阴性菌比值 Microbiology of Peritonitis There is variation in the microbial species most often involved in primary, secondary, and tertiary peritonitis. In a majority of patients, primary peritonitis is a result of a monobacterial infection, with E. coli being the most common pathogen.1 Other gram-negative bacteria, such as Klebsiella, are common in peritonitis, as are Streptococcus and Enterococcus species. The microbial etiology of secondary peritonitis depends on the level of gastrointestinal tract disruption.1 Mechanical small-bowel obstruction or an ischemic segment due to any cause results in microbial counts that are much higher than normal.2 Infection with E. coli and B. fragilis, especially in combination, can result in intra-abdominal abscesses and substantial mortality.2 Aerobic and anaerobic bacteria can synergistically enhance virulence; for instance, aerobic bacteria can lower redox potential, thus favoring growth of coexisting anaerobic bacteria.2 Polymicrobial isolates are obtained in more than two thirds of peritonitis and intra-abdominal abscess cases.2 Bacteria commonly involved in secondary peritonitis include the previously discussed B. fragilis and E. coli, as well as Clostridium, Klebsiella, Streptococcus, Enterococcus, and Pseudomonas species. In most clinical settings, 2 to 3 aerobic species and 1 to 2 anaerobic species are identified in patients with secondary peritonitis.2 I