The Comparative Analysis Of Invasive Pulmonary Fungal Infections In Clinical Between The Department Of Respiratory And ICU

ObjectiveTo investigate the clinical characteristics of pulmonary invasive fungal infections in the department of ICU and Respiratory about sputum culture for fungus.MethodsCollect the cases of sputum culture for fungus in 2008 from January to December in the department of Respiratory and ICU,which in lined with the diagnosis of invasive pulmonary fungal infection, comparative analysis of the clinical incidence, strain distribution, the primary disease, risk factors, treatment and prognosis.Results(1)In the department of ICU, the positive rate of sputum culture for fungus was higher than the department of Respiratory ,were 13.68% (74/541 ) and 2.45% (161/6576), P <0.01;The incidence of invasive pulmonary fungal infection of the sputum culture for fungus in the department of ICU was 45.95% (34/74), significantly higher than the department of Respiratory 6.13% (10/161), P <0.01; the cases which were not diagnosed invasive fungal pulmonary fungal infection with sputum culture for fungus, only using antibiotics in the department of Respiratory were higher than ICU ,were 93.79% (151/161) and 54.05% (40/74 ), P <0.01 ;(2)The most common pathogen for Candida albicans, followed by Candida parapsilosis and smooth Candida, constituent ratio between the two departments was no significant difference; The proportion of non-Candida albicans infection had also increased;(3) In the two departments, Candida albicans and non-Candida albicans had high susceptibility rate to Amphotericin B and 5 - Fluorocytosine,but Candida albicans had high resistant rate to Fluconazole, Itraconazole, Voriconazole , non-Candida albicans had some resistant rate to them;(4)The primary disease in the department of Respiratory were followed severe pneumonia (40.00%), tuberculosis (30.00%), pneumonia combined with congenital heart (20.00%); In ICU patients with congenital heart surgery (41.18%), severe pneumonia (17.65%), respiratory failure (17.65%), blood malignancies (5.88%) and gastro-intestinal diseases postoperative (5.88%);(5)The long course before diagnosis of Invasive pulmonary fungal infection ,application of carbapenem antibiotics, systemic corticosteroids, mechanical ventilation, surgical intervention, invasive indwelling pipeline, intravenous high-nutrition were risk factors, there was significant difference between the two departments (P <0.05), longtime hospitalization and had the use of antibiotics for three or more times, also were the risk factors ,but no statistical significance between the two departments;(6)The occurring of invasive pulmonary fungal infections had characteristics with age and season, in the two departments they were easy to occur in the infant and to a higher infection rate in winter and spring, there was no statistically significant difference;(7)According the results of sputum culture and drug sensitivity,the two departments choiced Amphotericin B or its liposomal, Fluconazole to systemic venous anti-fungal treatment,sensitive antibiotics resisted bacterial infection, nutrition support and comprehensive treatment , obtained more satisfactory outcome;(8)The cure rate in the department of ICU was 70.59%(24/34),lower than the department of Respiratory 90.00% (9/10), the invalid rate after treatment was 14.71% (5 /34) in the department of ICU,which was higher than the department of Respiratory 0.00% (0/10).Conclusions(1)The positive rate of sputum culture for fungus and incidence of the invasive pulmonary fungal infection of sputum culture for fungus in the department of ICU was significantly higher than that in the department of Respiratory; (2)Candida albicans was the most common opportunistic pathogen,but the non-Candida albicans infections had a trend to increase;(3)Invasive pulmonary fungal infection was often secondary to severe pneumonia, tuberculosis in the department of Respiratory ,but in the department of ICU,it was often secondary to the children with congenital heart surgery and respiratory failure;(4)The long course before diagnosis of Invasive pulmonary fungal infection, use of carbapenem antibiotics and systemic glucocorticoids, mechanical ventilation, surgical intervention, invasive indwelling pipeline, intravenous high nutritional were all the risk factors of Invasive pulmonary fungal infection in the department of ICU;(5) Invasive pulmonary fungal infection was easy to occur in the infant, for the peak of winter and spring;(6)Invasive pulmonary fungal infection in a patient ,we should choice sensitive drugs resist fungal infection, at the same time,should actively treat the primary disease, nutritional support to improve body resistance, comprehensive treatment,and so on;(7)The cure rate in department of ICU was lower than Respiratory, the invalid rate after treatment in department of ICU was higher than the department of Respiratory .