Tanaka H, Huruhata T, Gotou H, Sakurai M, Shimazaki S
Dept. of Traumatology and Critical Care Medicine Kyorin University, 6-20-2 Shinkawa, Mitaka City Tokyo, 181-0004, Japan.
Nihon Ishinkin Gakkai Zasshi. 1999;40(3):135-42. doi: 10.3314/jjmm.40.135.
Candidemia is still a major source of high morbidity and mortality in severely disease patients. However, the etiology and risk factor is still unknown.
To evaluate the risk factor of fungal infection in intensive care patients.
505 patients who stayed in the intensive care unit of the Critical Care Center, Kyorin University more than 10 days between May 1, 1997 to June 31, 1998 were studied. They were divided into 7 groups: 1) trauma (injury severity score<10), 2) burn (burn index<10), 3) cerebro-vascular disease (unconsciousness<JCS 10), 4) GI tract disease, 5) acute poisoning, 6) cardiac dysfunction, 7) sepsis and others. Background factors, such as ISS, AIS scores for various trauma sites, length of stay in ICU and length of ventilatory days, as well as the fungal culture derived from blood, sputum, urine and pharyngeal smear, and the serological diagnosis were compared for the seven groups.
Higher fungal detection was found in upper airways (oral and sputum culture), but little was detected in urine or blood samples. Groups in trauma, burn, GI tract disease and CVA disease showed a higher detection rate of fungal species and diagnosed fungal infection, while patients with association of severe chest injury, inhalation injury and coma were significantly higher in the fungal infection group, than those in the non-fungal infection (p<0.01). Length of stay in ICU and the length of respiratory days were significantly longer in the fungal infection group (p<0.001).
The frequency of fungal infection onset was higher in patients with severe ISS of 16 or higher, those who used the ventilator, had inhalation injury, severe burns (BI>15), were in a coma, and had severe injury of lung parenchyme with chest AIS 3 or higher. In these serious patients, it is necessary to make a rapid diagnosis and treatment based on the surveillance culture and serological examination of sputum and urine for occult fungal infection.
念珠菌血症仍是重症患者高发病率和高死亡率的主要来源。然而，其病因和危险因素仍不清楚。
评估重症监护患者真菌感染的危险因素。
对1997年5月1日至1998年6月31日期间在杏林大学重症监护中心重症监护病房住院超过10天的505例患者进行研究。他们被分为7组：1）创伤（损伤严重度评分<10），2）烧伤（烧伤指数<10），3）脑血管疾病（昏迷评分<10），4）胃肠道疾病，5）急性中毒，6）心功能不全，7）败血症及其他。比较了七组患者的背景因素，如损伤严重度评分（ISS）、各创伤部位的简明损伤定级标准（AIS）评分、在重症监护病房的住院时间和通气天数，以及血液、痰液、尿液和咽拭子涂片的真菌培养结果和血清学诊断结果。
在上呼吸道（口腔和痰液培养）中发现较高的真菌检出率，但在尿液或血液样本中检出较少。创伤、烧伤、胃肠道疾病和脑血管疾病组的真菌种类检出率和确诊真菌感染率较高，而合并严重胸部损伤、吸入性损伤和昏迷的患者真菌感染组明显高于非真菌感染组（p<0.01）。真菌感染组在重症监护病房的住院时间和呼吸天数明显更长（p<0.001）。
损伤严重度评分16分及以上的重症患者、使用呼吸机的患者、有吸入性损伤的患者、严重烧伤（烧伤指数>15）的患者、昏迷患者以及胸部简明损伤定级标准3分及以上的肺实质严重损伤患者，真菌感染的发生率较高。对于这些重症患者，有必要基于痰液和尿液的监测培养及血清学检查对隐匿性真菌感染进行快速诊断和治疗。
