Kochhar Rakesh, Ahammed S K Mahiuddin, Chakrabarti Arunaloke, Ray Pallab, Sinha Saroj K, Dutta Usha, Wig Jai Dev, Singh Kartar
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Gastroenterol Hepatol. 2009 May;24(5):743-7. doi: 10.1111/j.1440-1746.2008.05712.x. Epub 2009 Feb 9.
To study the prevalence of risk factors and outcome of fungal infections in patients with severe acute pancreatitis.
Fifty consecutive patients with severe acute pancreatitis were investigated for evidence of fungal infection by weekly culture of body fluids and aspirate from pancreatic/peripancreatic tissue and samples collected at necrosectomy. All patients were managed as per a standard protocol. Patients with documented fungal infection were treated with intravenous amphotericin or fluconazole. Data were analyzed using SPSS software (version 13), and risk factors for fungal infection and mortality were determined.
Fungal infection was documented in 18 (36%) of 50 patients with Candida albicans (the commonest species). The incidence of fungal infection steadily increased with increasing duration of hospital stay. Those with fungal infection more often had evidence of respiratory failure (P = 0.031) and hypotension (P = 0.031) at admission, prolonged hospital stay > 4 weeks (P = 0.034), longer duration of antibiotics (P = 0.003), received total parenteral nutrition (P = 0.005), and required mechanical ventilation (P = 0.001) in contrast to those without fungal infection. The logistic regression analysis found the independent risk factors for fungal infection to be antibiotic therapy for > 4 weeks and hypotension at hospitalization. Of the 18 patients with fungal infection, 13 were administered intravenous antifungals; eight of these patients survived, while the five who did not receive antifungals died.
Fungal infection was detected in 36% of our patients. The independent risk factors associated with it were hypotension at hospitalization and prolonged antibiotic therapy. Antifungal therapy improved their chances of survival.
研究重症急性胰腺炎患者真菌感染的危险因素及转归。
连续纳入50例重症急性胰腺炎患者，通过每周对体液、胰腺/胰周组织穿刺液及坏死组织清除术采集的样本进行培养，调查真菌感染证据。所有患者均按照标准方案进行治疗。确诊真菌感染的患者接受静脉注射两性霉素或氟康唑治疗。使用SPSS软件（13版）分析数据，确定真菌感染和死亡的危险因素。
50例患者中有18例（36%）确诊真菌感染，白色念珠菌（最常见菌种）感染最为常见。真菌感染的发生率随住院时间延长而稳步上升。与未发生真菌感染的患者相比，发生真菌感染的患者入院时更常出现呼吸衰竭（P = 0.031）和低血压（P = 0.031），住院时间延长> 4周（P = 0.034），抗生素使用时间更长（P = 0.003），接受全胃肠外营养（P = 0.005），且需要机械通气（P = 0.001）。逻辑回归分析发现，真菌感染的独立危险因素为抗生素治疗> 4周和住院时低血压。18例真菌感染患者中，13例接受了静脉抗真菌治疗；其中8例患者存活，5例未接受抗真菌治疗的患者死亡。
我们的患者中36%检测到真菌感染。与之相关的独立危险因素为住院时低血压和抗生素治疗时间延长。抗真菌治疗提高了患者的生存几率。
