老年危重症患者合并真菌感染的预后和相关因素分析

目的探讨老年危重症患者合并重要脏器严重真菌感染时的预后,并分析可能引起真菌感染的致病条件和因素等. 方法收集本院近些年来老年危重症感染患者共122例,按真菌混合感染和细菌感染分为2组,分析使用抗生素时其痰和血等培养出的致病菌种和构成. 结果真菌混合感染组真菌高达76株,白念珠菌50%和酵母菌1.6%,革兰阳性(G+)菌(41.3%,52/126株)较细菌组G+菌感染(56.9%,70/123株)低,t＝2.49,P＜0.01);而革兰阴性(G-)菌(60.3%,74/126株)较细菌组G-菌(43.1%,53/123株)高;t＝2.50,P＜0.01.可引起真菌感染的因素是感染器官/部位,导/引流管,急性生理评分和抗生素等.真菌出现时所用抗生素三代头孢菌素、氧哌嗪青霉素、喹诺酮类、美洛培南和万古霉素.2组中共死亡82例,真菌组死亡46例(74.2%),细菌组死亡36例(60%). 结论老年危重症患者真菌出现前后多伴有非常严重G-和G+菌混合感染,感染受累部位或器官和引流管或深静脉置管越多,以及多种超广谱抗生素应用等均可使其获得真菌感染的机会增加,且多预后不良.

Analysis of related factors and prognosis of aged and critical patients complicated with severe fungus infection

Objective To explore the prognosis and multi factors related to severe fungus infection in aged and critical patients. Methods One hundred and twenty two patients were divided into two groups,according to infection of fungus with bacterium and simple bacterium infection. Results Seventy six fungus strains were identified.They were candida(50 3%),yeast(32 4%),etc.G + strains41 3%(52/126)]in the fungus group appeared less often than G + strains 56 9%(70/123 )]( t=2 49,P<0 01) in bacterium group.On the contrary G - strains58 7%(74/126)]appeared more often than G - strains43 1%(53/123)]( t=2 50,P <0 01)in bacterium group.The potential factors of infection included organs and locations infected,catheters placed in body cavities and multi antibiotics used,etc.With the development of fungus infection the frequently used antibiotics are cephalosporin,piperacillin,quinolones and imipenem.Deaths accounted for 74 2%(46/82 cases)in fungus group,and 60%(36/60 cases)in bacteria group. Conclusions In the critically ill aged,fungi are more often found with bacterium infection.Risk factors involved are apt to result in severe fungus infection in aged patients and their prognoses will not be so bright.