• 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院呼吸科(北京 100029);

侵襲性真菌感染(IFI)不僅可發(fā)生在惡性血液病、惡性腫瘤、器官移植和AIDS等經(jīng)典免疫功能缺陷患者中,近年來ICU的重癥患者由于嚴(yán)重的基礎(chǔ)疾病、外科手術(shù)指征和范圍的擴(kuò)大、各種導(dǎo)管的體內(nèi)介入與留置,以及廣譜抗生素和糖皮質(zhì)激素的廣泛應(yīng)用等,IFI發(fā)病率也迅速增加。據(jù)統(tǒng)計,IFI占醫(yī)院獲得性感染的8%-15%。IFI病情進(jìn)展快速、兇險,已13益成為導(dǎo)致ICU危重病患者死亡的重要原因之一。引起ICU IFI的病原體包括念珠菌、曲霉、隱球菌、鐮刀霉、接合菌、肺孢子菌等,其中以念珠菌和曲霉最多見,占90% 以上。由于ICU危重癥患者多數(shù)屬非經(jīng)典IFI高危人群,臨床表現(xiàn)缺乏特異性,臨床診治極為困難。本文就ICU內(nèi)侵襲性念珠菌感染(Ic)和侵襲性曲霉感染(IA)的流行病學(xué)、診斷和治療進(jìn)展進(jìn)行闡述,以期對臨床有所裨益。

引用本文: 劉盛敏,朱光發(fā),梁瑛. 重癥加強(qiáng)治療病房侵襲性真菌感染的臨床研究進(jìn)展. 中國呼吸與危重監(jiān)護(hù)雜志, 2008, 08(6): 477-480. doi: 復(fù)制

1. Ostrosky-Zeichner L,Pappas PG.Invasive candidiasis in the intensive care unit.Crit Care Med,2006,34:857-863.
2. Meersseman W,Lagrou K,Maertens J,et al.Invasive aspergillosis in the intensive care unit.Clin Infect Dis,2007,45:205-216.
3. Vallés J,Mesalles E,Mariscal D,et al.A 7-year study of severe hospital-acquired pneumonia requiring ICU admission.Intensive Care Med,2003,29:1981-1988.
4. Wisplinghoff H,Bischoff T,Tallent SM,et al.Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study.Clin Infect Dis,2004,39:309-317.
5. Lipsett PA.Surgical critical care:fungal infections in surgical patients.Crit Care Med,2006,34(9 Suppl):S215-S224.
6. Hajjeh RA,Sofair AN,Harrison LH,et al.Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program.J Clin Microbiol,2004,42:1519-1527.
7. Pappas PG,Rex JH,Lee J,et al.A prospective observational study of candidemia:epidemiology,therapy,and influences on mortality in hospitalized adult and pediatric patients.Clin Infect Dis,2003,37:634-643.
8. De Waele JJ,Vogelaers D,Blot S,et al.Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy.Clin Infect Dis,2003,37:208-213.
9. Almirante B,Rodríguez D,Cuenca-Estrella M,et al.Epidemiology,risk factors,and prognosis of Candida parapsilosis bloodstream infections:case-control population-based surveillance study of patients in Barcelona,Spain,from 2002 to 2003.J Clin Microbiol,2006,44:1681-1685.
10. Benjamin DK Jr,Garges H,Steinbach WJ.Candida bloodstream infection in neonates.Semin Perinatol,2003,27:375-383.
11. Perfect JR,Cox GM,Lee JY,et al.The impact of culture isolation of Aspergillus species:a hospital-based survey of aspergillosis.Clin Infect Dis,2001,33:1824-1833.
12. Segal BH,Walsh TJ.Current approaches to diagnosis and treatment of invasive aspergillosis.Am J Respir Crit Care Med,2006,173:707-717.
13. Patterson TF.Advances and challenges in management of invasive mycoses.Lancet,2005,366:1013-1025.
14. 朱小敏,周新.侵襲性肺曲霉病的診斷與治療.中國呼吸與危重監(jiān)護(hù)雜志,2005,4:316-320.
15. Meersseman W,Wingaerden EV.Invasive aspergillosis in the ICU:an emerging disease.Intensive Care Med,2007,33:1679-1681.
16. Meersseman W,Vandecasteele SJ,Wilmer A,et al.Invasive aspergillosis in critically ill patients without malignancy.Am J Respir Crit Care Med,2004,170:621-625.
17. 曹彬,蔡柏薔,王輝,等.肺部真菌感染152例病原譜再評價.中華結(jié)核和呼吸雜志,2007,30:279-283.
18. Hartemink KJ,Paul MA,Spijkstra JJ,et al.Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med,2003,29:2068-2071.
19. Ascioglu S,Rex H,de Pauw B,et al.Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants:An International Consensus.Clin Infect Dis,2002,34:7-14.
20. 中華內(nèi)科雜志編輯委員會.血液病/惡性腫瘤患者侵襲性真菌感染的診斷標(biāo)準(zhǔn)與治療原則.中華內(nèi)科雜志,2005,44:554-556.
21. 中華內(nèi)科雜志編輯委員會.侵襲性肺部真菌感染的診斷標(biāo)準(zhǔn)與治療原則(草案).中華內(nèi)科雜志,2005,45:697-700.
22. 中華醫(yī)學(xué)會重癥醫(yī)學(xué)分會.重癥患者侵襲性真菌感染診斷與治療指南.中華內(nèi)科雜志,2007,46:960-966.
23. Vandewoude KH,Vogelaers D.Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.Clin Infect Dis,2007,44:380-381.
24. Bulpa P,Dive A,Sibille Y.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.Eur Respir J,2007,30:782-800.
25. Ostrosky-Zeichner L,Rex JH,Bennett J,et al.Deeply invasive candidiasis.Infect Dis Clin North Am,2002,16:821-835.
26. Hope WW,Walsh TJ,Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis,2005,5:609-22.
27. Charles PE,Dalle F,Aube H,et al.Candida spp.colonization significance in critically ill medical patients:a prospective study.Intensive Care Med,2005,31:393-400.
28. Bouza E,Guinea J,Peláez T,et al.Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.J Clin Microbiol,2005,43:2075-2079.
29. Pazos C,Ponto J,DelPalacio A.Contributionof(1,3)-beta-D-glucan chromogenic assay to diagnosisand therapeutic monitoring of invasive aspergillosis in neutropenic adult patients:a comparison with serial screening for circulating galactomannan.J Clinic Microbiol,2005,43:299-305.
30. Odabasi Z,Mattiuzzi G,Estey E,et al.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections:Validation,cutoff development,and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome.Clin Infect Dis,2004,39:199-205.
31. 呂沛華,趙蓓蕾,施毅,等.1,3-β-D葡聚糖檢測診斷侵襲性真菌感染的臨床價值.中華結(jié)核和呼吸雜志,2007,30:31-34.
32. Pfeiffer CD,F(xiàn)ine JP,Safdar N.Diagnosis of invasive aspergillosis using a galactomannan assay:a meta-analysis.Clin Infect Dis,2006,15,42:1417-1427.
33. 朱小敏,周新,蔡逸婷,等.血清半乳甘露聚糖檢測對器官移植術(shù)后侵襲性肺曲霉病的診斷價值.中國抗感染與化療雜志,2005,5:209-211.
34. Meersseman W,Lagrou K,Maertens J,et al.Galactomannan in Bronchoalveolar Lavage Fluid:A Tool for Diagnosing Aspergillosis in Intensive Care Unit Patients.Am J Respir Crit Care Med,2008,177:27-34.
35. Edwards JE Jr,Bodey GP,Bowden RA,et al.International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections.Clin Infect Dis,1997,25:43-59.
36. Piarroux R,Grenouillet P,Balvay V,et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med,2004,32:2443-2449.
37. Pappas PG,Rex JH,Sobel JD,et al.Guidelines for treatment of candidiasis.Clin Infect Dis,2004,38:161-189.
38. Herbrecht R,Denning DW,Patterson TF,et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.N Engl J Med,2002,347:408-415.
  1. 1. Ostrosky-Zeichner L,Pappas PG.Invasive candidiasis in the intensive care unit.Crit Care Med,2006,34:857-863.
  2. 2. Meersseman W,Lagrou K,Maertens J,et al.Invasive aspergillosis in the intensive care unit.Clin Infect Dis,2007,45:205-216.
  3. 3. Vallés J,Mesalles E,Mariscal D,et al.A 7-year study of severe hospital-acquired pneumonia requiring ICU admission.Intensive Care Med,2003,29:1981-1988.
  4. 4. Wisplinghoff H,Bischoff T,Tallent SM,et al.Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study.Clin Infect Dis,2004,39:309-317.
  5. 5. Lipsett PA.Surgical critical care:fungal infections in surgical patients.Crit Care Med,2006,34(9 Suppl):S215-S224.
  6. 6. Hajjeh RA,Sofair AN,Harrison LH,et al.Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program.J Clin Microbiol,2004,42:1519-1527.
  7. 7. Pappas PG,Rex JH,Lee J,et al.A prospective observational study of candidemia:epidemiology,therapy,and influences on mortality in hospitalized adult and pediatric patients.Clin Infect Dis,2003,37:634-643.
  8. 8. De Waele JJ,Vogelaers D,Blot S,et al.Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy.Clin Infect Dis,2003,37:208-213.
  9. 9. Almirante B,Rodríguez D,Cuenca-Estrella M,et al.Epidemiology,risk factors,and prognosis of Candida parapsilosis bloodstream infections:case-control population-based surveillance study of patients in Barcelona,Spain,from 2002 to 2003.J Clin Microbiol,2006,44:1681-1685.
  10. 10. Benjamin DK Jr,Garges H,Steinbach WJ.Candida bloodstream infection in neonates.Semin Perinatol,2003,27:375-383.
  11. 11. Perfect JR,Cox GM,Lee JY,et al.The impact of culture isolation of Aspergillus species:a hospital-based survey of aspergillosis.Clin Infect Dis,2001,33:1824-1833.
  12. 12. Segal BH,Walsh TJ.Current approaches to diagnosis and treatment of invasive aspergillosis.Am J Respir Crit Care Med,2006,173:707-717.
  13. 13. Patterson TF.Advances and challenges in management of invasive mycoses.Lancet,2005,366:1013-1025.
  14. 14. 朱小敏,周新.侵襲性肺曲霉病的診斷與治療.中國呼吸與危重監(jiān)護(hù)雜志,2005,4:316-320.
  15. 15. Meersseman W,Wingaerden EV.Invasive aspergillosis in the ICU:an emerging disease.Intensive Care Med,2007,33:1679-1681.
  16. 16. Meersseman W,Vandecasteele SJ,Wilmer A,et al.Invasive aspergillosis in critically ill patients without malignancy.Am J Respir Crit Care Med,2004,170:621-625.
  17. 17. 曹彬,蔡柏薔,王輝,等.肺部真菌感染152例病原譜再評價.中華結(jié)核和呼吸雜志,2007,30:279-283.
  18. 18. Hartemink KJ,Paul MA,Spijkstra JJ,et al.Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med,2003,29:2068-2071.
  19. 19. Ascioglu S,Rex H,de Pauw B,et al.Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants:An International Consensus.Clin Infect Dis,2002,34:7-14.
  20. 20. 中華內(nèi)科雜志編輯委員會.血液病/惡性腫瘤患者侵襲性真菌感染的診斷標(biāo)準(zhǔn)與治療原則.中華內(nèi)科雜志,2005,44:554-556.
  21. 21. 中華內(nèi)科雜志編輯委員會.侵襲性肺部真菌感染的診斷標(biāo)準(zhǔn)與治療原則(草案).中華內(nèi)科雜志,2005,45:697-700.
  22. 22. 中華醫(yī)學(xué)會重癥醫(yī)學(xué)分會.重癥患者侵襲性真菌感染診斷與治療指南.中華內(nèi)科雜志,2007,46:960-966.
  23. 23. Vandewoude KH,Vogelaers D.Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.Clin Infect Dis,2007,44:380-381.
  24. 24. Bulpa P,Dive A,Sibille Y.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.Eur Respir J,2007,30:782-800.
  25. 25. Ostrosky-Zeichner L,Rex JH,Bennett J,et al.Deeply invasive candidiasis.Infect Dis Clin North Am,2002,16:821-835.
  26. 26. Hope WW,Walsh TJ,Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis,2005,5:609-22.
  27. 27. Charles PE,Dalle F,Aube H,et al.Candida spp.colonization significance in critically ill medical patients:a prospective study.Intensive Care Med,2005,31:393-400.
  28. 28. Bouza E,Guinea J,Peláez T,et al.Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.J Clin Microbiol,2005,43:2075-2079.
  29. 29. Pazos C,Ponto J,DelPalacio A.Contributionof(1,3)-beta-D-glucan chromogenic assay to diagnosisand therapeutic monitoring of invasive aspergillosis in neutropenic adult patients:a comparison with serial screening for circulating galactomannan.J Clinic Microbiol,2005,43:299-305.
  30. 30. Odabasi Z,Mattiuzzi G,Estey E,et al.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections:Validation,cutoff development,and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome.Clin Infect Dis,2004,39:199-205.
  31. 31. 呂沛華,趙蓓蕾,施毅,等.1,3-β-D葡聚糖檢測診斷侵襲性真菌感染的臨床價值.中華結(jié)核和呼吸雜志,2007,30:31-34.
  32. 32. Pfeiffer CD,F(xiàn)ine JP,Safdar N.Diagnosis of invasive aspergillosis using a galactomannan assay:a meta-analysis.Clin Infect Dis,2006,15,42:1417-1427.
  33. 33. 朱小敏,周新,蔡逸婷,等.血清半乳甘露聚糖檢測對器官移植術(shù)后侵襲性肺曲霉病的診斷價值.中國抗感染與化療雜志,2005,5:209-211.
  34. 34. Meersseman W,Lagrou K,Maertens J,et al.Galactomannan in Bronchoalveolar Lavage Fluid:A Tool for Diagnosing Aspergillosis in Intensive Care Unit Patients.Am J Respir Crit Care Med,2008,177:27-34.
  35. 35. Edwards JE Jr,Bodey GP,Bowden RA,et al.International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections.Clin Infect Dis,1997,25:43-59.
  36. 36. Piarroux R,Grenouillet P,Balvay V,et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med,2004,32:2443-2449.
  37. 37. Pappas PG,Rex JH,Sobel JD,et al.Guidelines for treatment of candidiasis.Clin Infect Dis,2004,38:161-189.
  38. 38. Herbrecht R,Denning DW,Patterson TF,et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.N Engl J Med,2002,347:408-415.
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    驗證治療措施的公平——高質(zhì)量研究促進(jìn)高質(zhì)量衛(wèi)生保健(Ⅷ)