伏立康唑治疗101例重症患者侵袭性真菌感染的临床分析

目的 观察伏立康唑治疗重症患者侵袭性真菌感染(IFI)的临床疗效及安全性.方法 回顾性分析医院ICU2005-2010年101例侵袭性真菌感染的病原学特点、伏立康唑的有效率、患者死亡率及不良反应.结果 101例重症侵袭性真菌感染患者中,确诊8例,占7.9％,临床诊断44例,占43.6％,拟诊49例,占48.5％,3组均具备真菌感染的多项危险因素;88例患者痰细菌培养为阳性,血培养阳性者19例,其中真菌血症8例;患者自发热至应用伏立康唑的时间为(9.1±6.6)d,52例患者有真菌学依据;确诊、临床诊断、拟诊3组有效率分别为25.0％、70.5％、71.4％,确诊组有效率低于临床诊断与拟诊组(P＜0.05),总有效率为67.3％.结论 伏立康唑能安全、有效地控制重症患者的侵袭性真菌感染,对于IFI拟诊患者,应尽早给予经验性治疗.

Clinical analysis of voriconazole in treatment of invasive fungal infections in 101 critically ill patients

OBJECTIVE To investigate the clinical efficacy and security of voriconazole in the treatment of invasive fungal infections(IFI) in the critically ill patients.METHODS The aetiology,efficacy and adverse reaction of voriconazole and death rate of 101 IFI patients from 2005 to 2010 in ICU were retrospectively analyzed.RESULTS Among the 101 critically IFI patients,there were totally 8 cases(7.9%) with confirmed diagnosis,44 cases(43.6%) with clinical diagnosis and 49 cases(48.5%) with suspected diagnosis.All patients in the 3 groups had many risk factors of fungal infections.88 patients had positive sputum bacterial culture and 19 patients had positive blood culture.There were 8 cases of fungemia.Time from fever to administration of voriconazole was(9.1±6.6) days.Mycological evidence was found in 52 cases.The effective rates in patients with confirmed diagnosis,clinical diagnosis and suspected diagnosis were 25.0%,70.5% and 71.4%,respectively.The effective rate in patients with confirmed diagnosis was significantly lower than patients with clinical diagnosis and suspected diagnosis(P<0.05).The total effective rate was 67.3%.CONCLUSION Voriconazole is effective and safe in the IFI treatment in critically ill patients.The empirical treatment should be provided for patients with suspected IFI.