ICU的侵袭性念珠菌感染.pptx

ICU侵袭性念珠菌感染东南大学从属中大医院重症医学科郭凤梅ICU的侵袭性念珠菌感染第1页

内容重视ICUICIICI流行病学特征重症患者ICI危险原因ICI治疗时机和治疗药品选择ICU的侵袭性念珠菌感染第2页

HilmarW,etal.CID;39:309–17ICI是院内感染主要组成a:P0.05forpatientsinICUsvs.patientsinnon-ICUwards.b:Significantlymorefrequentinpatientswithoutneutropenia.c:Significantlymorefrequentinpatientswithneutropenia.1995.3-.9美国49家医院24,179例院内血流感染病原学分析显示:念珠菌血流感染占血流感染9%，排名第四；病死率39.2%，排名第一ICU的侵袭性念珠菌感染第3页

EPICIEPIC(Euro,1992)17countries,1417ICUs4501patients(44.8%)wereinfectedICU的侵袭性念珠菌感染第4页

ICU感染流行病学全球调查(EPICⅡ)研究设计：全球多国多中心ICU患者感染流行病学调查研究对象：75国家1,265个ICU14,414患者(.5)研究结果：总感染率为51%，阳性菌株中真菌占19%念珠菌感染88%，仍为ICU真菌感染主要菌属-5-JAMA;302(21):2323-2329ICU的侵袭性念珠菌感染第5页

JAMA;302(21):2323-2329EPICIIIncidenceofinfectionwithCandidaincreasedtothethirdICU的侵袭性念珠菌感染第6页

念珠菌是IFI主要致病菌AmulticenterItaliansurvey(AURORAProject).2-.8,16hospitals18ICUs(=18y)Recoveryofyeastfrombloodcultureorothernormallysterilesite念珠菌霉菌总例数IFI92(念珠菌血症)13(曲霉12)105ICU患者数5561发病率18.9/1000Infection()41:645–653ICU的侵袭性念珠菌感染第7页

OverviewofattributablemortalityincandidemiaStudydesignAttributable

mortalityrateRetrospectivereview,1996-1999;130fatalcases

(Chengetal.,)42.3%Case-controlledstudy,1998-:Connecticut214cases,789controls;Baltimore529cases,2,065controls(Morganetal.,)19-24%Retrospective,case-controlledstudy,1997-;108cases,108controls(Gudlaugssonetal.,)49%Case-controlledstudyinlivertransplantrecipients,1985-1992;26cases,52controls(Nieto-Rodriguezetal.,1996)71%Prospectivecohortstudy,1993-1995;4,276admissions,42cases(Blumbergetal.,)41%Activepopulation-basedlaboratorysurveillancestudy,1999-;207admissions,207cases(Lauplandetal.,)40%Retrospectivereview,1991-(Pfalleretal.,)10-49%Retrospectivereview,-;318cases(Bassettietal,)43.5%ICU的侵袭性念珠菌感染第8页

MortalityofCandidiasisPublishtimeSettingResearchtime#ICUSubject#ptsIncidenceMortalityItaly-38ICI3181.01%46.0%Global-5-714