[临床医学]重症患者侵袭性真菌感染诊断和治疗指南.pptx

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）
ICU真菌感染的特点
抗真菌治疗
_____
临床诊断
、
Pat at risk of developing IFD
Liver
LUng
CGD
Transplant
Haematological malignancy Allogeneic HSCT
Burns
From Donnelly JP
1. SEC 1996-1998
Yeast fungi (Candida): %
C albicans 40%
C tropicalis 60% I
Mould fungi: %
2. PUMCH 1950-1990
Biopsy: Yeast fungi :15%
Mould fungi: 85%
A prospective multicenter study in 435 non-neutropenic pats New occurrence of invasive mycosis Fungal colonization: 64%
Candida species 56% Aspergillus 4%
Intensive Care Vletl. 1997. 23,317
ratnogenesis invasive Candida
infections y川 rm .
• Most systemic infections with (Sandlai
albicans are caused by endogenous organisms via translocation from the gastrointestinal tract or by sequential spread from other body sites
• Apparent outbreaks off infection have
been reported, raising the possibility of horizontal transmission
i Average of 39% of surgical ICU staff were found to carry Candida species
■ Infection control measures may be valuable
From 34th ICAAC, Orlancto. Florida
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皋
Charles PE et al. Intensive Care Med. 2003;29:2162-2169<
歯（非真蘭）血症
念珠歯血症
n
氏\\\
擎坏困恳
49家美国医院开展的为期3年的医院内血液感染的蓝测研究.
5°
汶)& 車OS
Edmanil \iB hailaccSf^ ycC lijrhDK. Pfaller t Jones RN. Denzel RP (^111 infect Dis 1999;29:239-244.
Epidemiology of Invasive Aspergillosis
Prospective Survey in France (1994-1999) ,
Hospital locations of 621 proven (n=115)膈；i ] or probable (n=506) cases
icu
—Immunological units
—Infectious disease wards
Miscellaneous wards (including Internal medicine/ Respiratory units)
Overall crude mortality = 63% (375/598)
Adapted from Cornet M et al.
Invasive Aspergil Critically III Pats Malignancy
• 1,850 pats in a medical
ICU
Microbiological or histopathologic
evidence of infection
with Aspergillus: %
• Aspergillus fumigatus:
96%
Am J Respir Crit Carv \feiL 200-1 f 170. 62i