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目的 探讨真菌败血症的治疗及早期诊断 ,以改善预后。方法 结合文献复习 ,回顾性研究 1992年 8月～ 2 0 0 0年 9月间的 15例真菌败血症患者的临床特征、治疗效果及预后。结果 15例中 ,除 1例为社区获得性感染外 ,14例为医院获得性感染 ;后者首次阳性血培养前的住院时间 7d～12个月 ,中位数为 1 5个月。易感危险因素中 ,以严重基础疾病 (10例 / 15例 )、使用广谱抗生素 (14例/ 15例 )、应用糖皮质激素或化疗药物 (11例 / 15例 )的因素最为突出 ,少数 (4例 / 15例 )有中性粒细胞减少。而具有上述两种以上易感危险因素者达 11例。主要致病菌为念珠菌属包括白色念珠菌和非白色念珠菌属 (如热带念珠菌、近平滑念珠菌等 )。病死率为 5 3 3% (8/ 15 )。对抗真菌治疗有效的 7例中 ,合并心内膜炎的 2例成功地施行了瓣膜赘生物 (直径均 >1cm)清除术。结论 本组败血症多发生在机体防御功能明显降低的患者中 ,主要致病菌为白色念珠菌和非白色念珠菌属 ,尽可能及早明确诊断和治疗有助于降低病死率。
Objective To investigate the treatment and early diagnosis of fungal sepsis to improve the prognosis. Methods Combined with literature review, the clinical features, therapeutic effects and prognosis of 15 cases of fungal sepsis from August 1992 to September 2000 were retrospectively studied. Results Of the 15 cases, except for one case of community-acquired infection, 14 cases were hospital-acquired infections. The first positive blood culture was hospitalized for 7 days to 12 months with a median of 15 months. Of the predisposing risk factors, there were the most prominent factors of serious underlying diseases (10 cases / 15 cases), broad-spectrum antibiotics (14 cases / 15 cases) and glucocorticoid or chemotherapeutic drugs (11 cases / 15 cases) (4 cases / 15 cases) have neutropenia. Eleven patients had the above two or more risk factors. The main pathogens are Candida species including Candida albicans and non-Candida albicans (such as Candida tropicalis, Candida parapsilosis, etc.). The case fatality rate was 53.3% (8/15). Of the 7 cases effective against fungi, 2 patients with endocarditis successfully performed removal of valve neoplasms (> 1 cm in diameter). Conclusion This group of sepsis occurred in patients with significantly reduced body defense function, the main pathogens are Candida albicans and non-Candida albicans, as soon as possible to confirm the diagnosis and treatment can help reduce mortality.