重症患者侵袭性真菌感染诊断和治疗指南课件.ppt

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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.Youguysge

2、talltheattentionFusariumThemainplayersFromDonnellyJP1.SEC1996-1998Yeastfungi(candida):91.4%Calbicans40%Ctropicalis60%Mouldfungi:5.9%2.PUMCH1950-1990Biopsy:Yeastfungi:15%Mouldfungi:85%真菌感染菌株Aprospectivemulticenterstudyin435non-neutropenicpatsNewoccurrenceofinv

3、asivemycosisFungalcolonization:64%Candidaspecies56%Aspergillus4%IntensiveCareMed,1997,23,317PathogenesisinvasiveCandidainfectionsMostsystemicinfectionswithCandidaalbicansarecausedbyendogenousorganismsviatranslocationfromthegastrointestinaltractorbysequential

4、spreadfromotherbodysitesApparentoutbreaksofinfectionhavebeenreported,raisingthepossibilityofhorizontaltransmissionAverageof39%ofsurgicalICUstaffwerefoundtocarryCandidaspeciesInfectioncontrolmeasuresmaybevaluableFrom34thICAAC,Orlando,FloridaICU患者念珠菌血症的高危因素10年(

5、1990-2000)的回顾性荟萃分析患者比例(%)CharlesPEetal.IntensiveCareMed.2003;29:2162-2169.念珠菌感染的预后--高死亡率EdmondMB,WallaceSE,McClishDK,PfallerMA,JonesRN,WenzelRPClinInfectDis1999;29:239-244.49家美国医院开展的为期3年的医院内血液感染的监测研究EpidemiologyofInvasiveAspergillosisProspectiveSurveyinFrance

6、(1994-1999)Hospitallocationsof621proven(n=115)orprobable(n=506)cases63%4%6%15%12%HaematologicalwardsMiscellaneouswards(includingInternalmedicine/Respiratoryunits)InfectiousdiseasewardsImmunologicalunitsICUOverallcrudemortality=63%(375/598)AdaptedfromCornetM

7、etal.InvasiveAspergillosisinCriticallyIllPatswithoutMalignancy1,850patsinamedicalICU127例确诊/临床诊断曲霉菌病MicrobiologicalorhistopathologicevidenceofinfectionwithAspergillus:6.9%Aspergillusfumigatus:96%Aspergillusniger:3isolateAspergillusflavus:1isolateAmJRespirCritC

8、areMed,2004,170:6217%CrudeMortalityforInvasiveAspergillosis86%(109/127)69%100%(38/38)48%80%(71/89)PatswithmalignancyCasefatalityrate(%)OverallPredictedMbySAPSIIICUmortality907050302001040