ICU患者侵袭性真菌感染诊治现状的调查与分析

发布时间：2018-04-02 17:22

  本文选题：回顾性研究　切入点：侵袭性真菌感染　出处：《石河子大学》2014年硕士论文

【摘要】：目的：调查入住石河子地区某医院重症医学科（ICU）患者侵袭性真菌感染（IFI）的发病特点，致病真菌的耐药情况，抗真菌药物治疗情况及效果。分析ICU病房IFI感染的危险因素，评价抗真菌药物使用规范性、合理性，为防治IFI的合理用药提供参考依据。 方法：采用回顾性调查研究的方法，将2012年1月～2013年12月入住ICU经筛选符合条件的患者作为研究对象，调查分析IFI患者的一般情况、致病真菌的分离培养及药敏试验结果、使用抗真菌药物情况，治疗转归等。参照药品说明书及相关真菌病治疗指南，建立抗真菌药物应用评价标准，对临床应用抗真菌药物的合理性进行评价，开展抗真菌药物的利用评价。以临床诊断及确诊患者为IFI组，随机选取非IFI患者为对照组，用病例对照研究方法，分析ICU患者发生IFI的危险因素，利用SPSS软件进行Logistic回归分析，筛选出主要的独立危险因素。 结果：符合调查条件的546例患者中发现113例IFI患者，发病率为20.70%，其中确诊7例，临床诊断71例，拟诊35例。从血液、尿液、痰液、胸腹水、伤口分泌物等标本中共分离出菌株61株均为酵母菌，其中白色假丝酵母菌49株（80.33%）。药敏试验结果显示不同药物对真菌的敏感性有明显的差异。107例患者行抗真菌药物治疗，其中经验治疗33例，抢先治疗67例，目标治疗7例。共有氟康唑、伏立康唑、两性霉素B、卡泊芬净等4种药物被使用，其中药物单用84例，联合用药23例。评价了治疗1周以上的82例患者治疗效果，总有效率分为40.24%，病死率为25.61%。调查应用抗真菌药物治疗病历109例，药物应用评价结果合理101例(92.7%)，药物利用评价显示氟康唑使用频次最高，药物利用指数也最高。分析了IFI感染的17项因素均为患者发生IFI的危险因素，其中6项有统计学意义，经多重回归分析，筛选出脓毒症（感染性休克）、肿瘤、使用广谱抗生素≥5天、深静脉置管、机械通气≥3天等5项为独立危险因素。 结论：ICU患者IFI发病率较高，已成为ICU常见感染性疾病，但绝大多数IFI难以确诊，多数患者接受抗真菌治疗是在拟诊及临床诊断的基础上，急需统一规范治疗标准。感染病原菌以白假丝酵母菌最常见，对两性霉素B的敏感性较好，对其它常用药有不同程度耐药。IFI治疗的主要策略是经验性用药及抢先治疗，可选择药物少，治疗效果有待提高。以自拟的抗真菌药物临床应用评价标准评价，ICU应用抗真菌药物合理性较高，多数药物利用指数DUI1.0，结果符合诊疗发展的趋势。研究显示常用药物DDC较大，患者经济负担重。考察的17项因素，ICU患者发生IFI的危险因素多，与原发疾病、并发症及侵入性诊治，，抗菌药物应用等有关。经多因素Logistic回归分析筛选出5项独立危险因素，结论仅供参考。应对侵袭性真菌感染的诊断与药物治疗等加以深入研究。
[Abstract]:Objective: to investigate the characteristics of invasive fungal infection (IFI), the drug resistance of pathogenic fungi, and the treatment of antifungal drugs in patients with ICU in a hospital in Shihezi area.To analyze the risk factors of IFI infection in ICU ward, to evaluate the standardization and rationality of antifungal drug use, and to provide a reference for the prevention and treatment of IFI.Methods: a retrospective study was conducted to investigate and analyze the general conditions of IFI patients, the isolation and culture of pathogenic fungi and the results of drug sensitivity test.Use of antifungal drugs, treatment outcome and so on.According to the drug instructions and the guidelines for the treatment of mycosis, the evaluation criteria for the application of antifungal drugs were established, the rationality of the clinical application of antifungal drugs was evaluated, and the utilization evaluation of antifungal drugs was carried out.The patients with clinical diagnosis and diagnosis were selected as IFI group and non-#en1# patients were randomly selected as control group. The risk factors of IFI in ICU patients were analyzed by case-control study. The main independent risk factors were screened by Logistic regression analysis with SPSS software.Results: 113 cases of IFI were found out of 546 patients who met the conditions of investigation, the incidence rate was 20.70,7 cases were diagnosed, 71 cases were clinically diagnosed, and 35 cases were to be diagnosed.A total of 61 strains were isolated from blood, urine, sputum, pleural effusion and wound secretion, among which 49 strains were Candida albicans.The results of drug sensitivity test showed that there were significant differences in the sensitivity of different drugs to fungi. 107 patients were treated with antifungal drugs. Among them, 33 cases were treated by experience, 67 cases by preemptive treatment, and 7 cases by target therapy.Four kinds of drugs, fluconazole, volconazole, amphotericin B and carpofen, were used, among which 84 cases were used alone and 23 cases were treated in combination.82 patients who had been treated for more than one week were evaluated. The total effective rate was 40.24 and the mortality was 25.61.109 cases were treated with antifungal drugs. The results of evaluation were reasonable in 101 cases. The drug utilization evaluation showed that fluconazole use frequency was the highest and drug utilization index was the highest.All the 17 factors of IFI infection were analyzed as the risk factors of IFI in the patients. Six of them were statistically significant. Sepsis (septic shock, tumor, broad-spectrum antibiotic 鈮

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