Investigation And Analysis Of Patients With Invasive Pulmonary Fungal Infection In EICU

Objective: To detect the species,quantity and drug resistance of respiratory tract fungus;to analyze the risk factors in patients with invasive pulmonary fungal infection(IPFI)in ICU of our hospital,and to explore the clinical application of antifungal drugs.Our study was designed to improve the economic benefit and scientific of antifungal drug.Methods: A total of 2190 samples of sputum and alveolar lavage fluid of 1040 patients who were in EICU in Lanzhou Shihua hospital were collected between Jan 2010 and Dec 2015.Samples were performed with identification of pathogenic bacteria species and drug sensitive test.Totally,286 of fungi positive,128 of patients were found through the microbiology test,among them 47 patients with IPFI were selected as subjects.Meanwhile,47 healthy cases(control)were selected.We collected many indices including gender,age,basic diseases,biochemical items,invasive operation,identification of pathogenic microorganism,culture and drug sensitive test of microbiology examination,selection and use of antifungal drugs,antibiotics and glucocorticoid use.Finally,the risk factors of IPFI,rationality of antifungal drugs use were analyzed.Results: 1.Fungi species and composition in patients with IPFI: A total of 286 fungal strains were found,accounting for 13.06% of the total numbers of respiratory pathogens.Among the isolated fungus,the predominated one is candida albicans(249 strains,87.07%).Other fungus were also found,which included 18 smooth candida(6.29%),12 Candida parapsilosis(4.20%),4 Candida tropicalis(1.40%)and 3 Candida krusei(1.05%).No Aspergillus or Mucorales was found.2.The fungal susceptibility testing results: The results of susceptibility testing showed that the sensitivity of detected fungus to 5-fluorine cytosine and amphotericin B were 100%,and resistant rate to fluconazole,itraconazole and voriconazole was 4.90%,2.80% and 0.35%,respectively.The resistant rate of candida albicans to fluconazole was 2.0%.Resistant rate of Candida krusei,Candida glabrata and Candida parapsilosis to fluconazole was 66.67%,22.22% and 25.0%,respectively,and to itraconazole was 33.33%,16.67% and 33.33%,respectively.3.The clinical diagnosis and treatment: A total of 128 cases were detected with fungi.Among them 47 cases(36.71%)were diagnosed as IPFI and 72 cases(56.25%)as fungi colonize.The diagnosis of IPFI is mainly through clinical diagnosis.However,the confirmed cases were rare.IPFI incidence was 4.52%.Fluconazole was used with highest frequency,followed by voriconazole and mooring Finn net card.However,amphotericin B and 5-fluorine cytosine was not used in our hospital.Effective rate of voriconazole and fluconazole was significant..The pathogenic bacteria in our hospital were mainly candida albicans.4.Risk factor analysis: Risk factor analysis revealed that mechanical ventilation(OR = 6.98,95% CI = 1.77–27.44,P < 0.01),deep venipuncture(OR = 4.07,95% CI = 1.40–1.83,P < 0.05),malignant tumor(OR = 2.32,95% CI = 1.18–4.53,P < 0.05),broad-spectrum antibiotics for more than two kinds(OR = 5.71,95% CI = 2.08–15.69,P < 0.05),broad-spectrum antibiotics more than 2 weeks(OR = 6.47,95% CI = 2.36-17.73,P < 0.01)and the application of glucocorticoid hormone(OR = 3.64,95% CI = 1.72–7.77,P < 0.05)are independent risk factors.Conclusion: Fungi is a common respiratory pathogens.The main pathogenic bacteria for EICU patients with IFPI in our hospital were Candida,of which the most common one is candida albicans,smooth candida and Candida parapsilosis.There was no mucor or aspergillus.No resistance of 5-fluorine cytosine or amphotericin B was found.The sensitivity of voriconazole is higher than fluconazole and itraconazole.The number of cases of clinical diagnosis of IPFI is low,and the confirmed cases were rare.The use frequency of fluconazole is highest,followed by voriconazole and mooring Finn net card.Mechanical ventilation,deep venipuncture,malignant tumor,broad-spectrum antibiotics for more than two,broad-spectrum antibiotics more than 2 weeks and the application of glucocorticoid hormone are independent risk factors for EICU patients with IPFI.