重症患者真菌感染聚焦念珠菌及氟康唑的地位.pptxVIP

重症患者侵袭性真菌感染—— 聚焦念珠菌感染及氟康唑的地位提 要ICU与感染危重病人侵袭性真菌感染念珠菌来源抗真菌药物及选择关于氟康唑提 要ICU与感染危重病人侵袭性真菌感染念珠菌来源抗真菌药物及选择关于氟康唑ICU 感染患者感染性疾病诊治感染的预防与控制重症感染入住ICUICU获得感染 （ICU-acquired infections）ICU内获得性感染的预防与控制感染相关问题是ICU永恒主题ICU 工作要点之一是感染75 countries1265 ICUS13 796 patients7087 (51.4%) infected patients9084 (71%) receiving antibioticsICU mortality rate 25% (infected) 11% (non-infected) (p .001)Infection accounted for 40% of total ICU expendituresSite of infection 7087 (51.4% of 13 796 )Respiratory tract450363.5%Abdominal139219.6%Bloodstream107115.1%Renal/urinary tract101114.3%Skin4676.6%Catheter-related3324.7%CNS2082.9%Distribution of Nosocomial Infections by Site in Medical-Surgical ICU in USInfect Control Hosp Epidemiol. 2000;21:510-515.Distribution of Nosocomial Infections by Site in Medical-Surgical ICU in USInfections at three major sites represented 68% of all reported infections Nosocomial pneumonia 31% Urinary tract infections (UTIs) 23% Bloodstream infections (BSIs) 14%83% of episodes of nosocomial pneumonia were associated with mechanical ventilation (VAP)97% of UTIs occurred in catheterized patients (CAUTI)87% of primary BSIs in patients with a central line (CRBSI)ICU 与 感染感染相关问题是ICU永恒主题ICU 工作要点之一是感染(51% 感染病人）ICU感染病人：呼吸、腹腔、泌尿、血流ICU获得感染：呼吸、泌尿、血流、(手术部位-SICU)提 要ICU与感染危重病人侵袭性真菌感染真菌感染诊断相关问题抗真菌药物抗真菌药物选择ICU感染的病原学细菌 (G+; G-; 厌氧菌)不典型细菌真菌病毒etc…日本Toho 1955-2006年间的10297例尸检进行分析Mycoses. 2012, 55: 435–443Mycoses. 2012, 55: 435–443Among 2,984 ICU admissions, there were 489 deaths222 autopsies were conducted Post mortem examination revealed unexpected findings in 50 patientsMalignancy22Fungal infections (most aspergilosis)9Pulmonary embolism7Nosocomial infections3Other Intensive Care Med. 2004,30:2080–2085Critical and urgent care: 61-73Positive isolates ( 4947 / 7087 = 70%)Gram- negative307762.20%Gram- positive 231546.80%FungiCandida84317%Aspergillus701.4%Others501.0%Vincent JL, et al. JAMA. 2009, 302(21): 2323-2329.Aspergillus 57 Mucormycosis