《真菌感染-讲义》PPT课件

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1、重症患者侵袭性真菌感染诊断和治疗指南（中华医学会重症医学分会）杨毅东南大学医学院附属中大医院ICU内容提要抗真菌治疗临床诊断ICU真菌感染的特点InvasivefungaldiseaseHaematologicalmalignancyAllogeneicHSCTICUCGDBurnsLiverHeartTransplantRenalLungPatatriskofdevelopingIFDHIVCandidaAspergillusHiBud!Hipal!Opportunityknocks!Huh.YouguysgetalltheattentionFusariumThem

2、ainplayersFromDonnellyJP1.SEC1996-1998Yeastfungi(candida):91.4%Calbicans40%Ctropicalis60%Mouldfungi:5.9%2.PUMCH1950-1990Biopsy:Yeastfungi:15%Mouldfungi:85%真菌感染菌株Aprospectivemulticenterstudyin435non-neutropenicpatsNewoccurrenceofinvasivemycosisFungalcolonization:64%Candidaspecies56%Asper

3、gillus4%IntensiveCareMed,1997,23,317PathogenesisinvasiveCandidainfectionsMostsystemicinfectionswithCandidaalbicansarecausedbyendogenousorganismsviatranslocationfromthegastrointestinaltractorbysequentialspreadfromotherbodysitesApparentoutbreaksofinfectionhavebeenreported,raisingthepossi

4、bilityofhorizontaltransmissionAverageof39%ofsurgicalICUstaffwerefoundtocarryCandidaspeciesInfectioncontrolmeasuresmaybevaluableFrom34thICAAC,Orlando,FloridaEpidemiologyofInvasiveAspergillosisProspectiveSurveyinFrance(1994-1999)Hospitallocationsof621proven(n=115)orprobable(n=506)cases63

5、%4%6%15%12%HaematologicalwardsMiscellaneouswards(includingInternalmedicine/Respiratoryunits)InfectiousdiseasewardsImmunologicalunitsICUOverallcrudemortality=63%(375/598)AdaptedfromCornetMetal.InvasiveAspergillosisinCriticallyIllPatswithoutMalignancy1,850patsinamedicalICU127例确诊/临床诊断曲霉菌病

6、MicrobiologicalorhistopathologicevidenceofinfectionwithAspergillus:6.9%Aspergillusfumigatus:96%Aspergillusniger:3isolateAspergillusflavus:1isolateAmJRespirCritCareMed,2004,170:6217%CrudeMortalityforInvasiveAspergillosis86%(109/127)69%100%(38/38)48%80%(71/89)PatswithmalignancyCasefatalit

7、yrate(%)OverallPredictedMbySAPSIIICUmortality9070503020010406080PredictedMbySAPSIIICUmortalityPatswithoutmalignancyAmJRespirCritCareMed,2004,170:621ICU患者侵袭性真菌感染的高危因素immunocompromisedICU患者的免疫状态immunoparalysisimmunocompetentICU患者与其它科室的患者相比，最突出的特点是其解剖生理屏障完整性的破坏。ICU患者往往带有多种插管，且消化道难