Castaldo P, Stratta R J, Wood R P, Markin R S, Patil K D, Shaefer M S, Langnas A N, Reed E C, Li S J, Pillen T J
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Arch Surg. 1991 Feb;126(2):149-56. doi: 10.1001/archsurg.1991.01410260033005.
During a 50-month period, we identified 91 episodes of fungal infection in 72 liver transplant recipients (23.8%). Candida species accounted for 83.5% of cases. Clinical patterns of fungal infections included disseminated infection (19), peritonitis (17), pneumonitis (15), multiple sites of colonization (13), fungemia (11), and other sites (16). The diagnosis of fungal infection was usually made in the first 2 months (84.7% of cases), at a mean time of 16 days after transplantation. Risk factors for fungal infections included retransplantation, Risk score, intraoperative transfusion requirement, urgent status, Roux limb biliary reconstruction (in adults), steroid dose, bacterial infections and antibiotic therapy, and vascular complications. Fungal infections were successfully treated with amphotericin B in 63 cases (74.1%) but were associated with diminished patient survival (50% vs 83.5%). Fungal infection is a frequent source of early morbidity and can be related to well-defined risk factors, suggesting the need for effective prophylaxis.
在50个月的时间里，我们在72例肝移植受者中发现了91次真菌感染事件（占23.8%）。念珠菌属占病例的83.5%。真菌感染的临床类型包括播散性感染（19例）、腹膜炎（17例）、肺炎（15例）、多部位定植（13例）、真菌血症（11例）和其他部位感染（16例）。真菌感染的诊断通常在头2个月内做出（84.7%的病例），平均在移植后16天。真菌感染的危险因素包括再次移植、风险评分、术中输血需求、紧急状态、Roux袢胆道重建（成人）、类固醇剂量、细菌感染和抗生素治疗以及血管并发症。63例（74.1%）患者使用两性霉素B成功治疗了真菌感染，但这与患者生存率降低相关（50%对83.5%）。真菌感染是早期发病的常见原因，并且可能与明确的危险因素相关，这表明需要进行有效的预防。
