Department of Internal Medicine, Tungs' MetroHarbor Hospital, Taichung, Taiwan.
J Microbiol Immunol Infect. 2009 Oct;42(5):378-84.
Increased risk for fungal infections has been observed in high-risk surgical patients, but the prognostic factors and impact of antifungal agents in this patient population are uncertain, especially in patients undergoing abdominal operation. This study was performed to ascertain the prognostic factors for patients with culture-positive Candida spp. who have had abdominal surgery.
From 2003 through 2006, all adult patients with positive candidal culture from abdominal specimens (peritoneal fluid obtained during laparotomy or drain effluent, abscess, or bile) at China Medical University Hospital, Taichung, Taiwan, were included in this retrospective study. Patients' demographic data, prognostic factors, and 30-day mortality rate related to fungal infection were analyzed by reviewing the medical charts.
Thirty nine patients were enrolled in the study. The overall mortality rate was 35.9%. Candida albicans was the most common isolate (82.5%). The major prognostic factors were number of surgical interventions, Gram-negative bacteremia, high Acute Physiology And Chronic Health Evaluation (APACHE) II score, corticosteroid use, and subsequent candidal infection (p < 0.05).
In patients with positive intra-abdominal candidal culture, greater numbers of surgical intervention, Gram-negative bacilli bacteremia, and high APACHE II score were the prognostic factors for mortality. Corticosteroid use might be a risk factor for subsequent candidal infection.
高危手术患者的真菌感染风险增加，但该患者人群的预后因素和抗真菌药物的影响尚不确定，尤其是在接受腹部手术的患者中。本研究旨在确定接受过腹部手术且培养出阳性念珠菌属患者的预后因素。
回顾性分析 2003 年至 2006 年中国台湾台中中国医药大学附设医院腹部标本（剖腹术中获得的腹膜液或引流液、脓肿或胆汁）中阳性念珠菌培养的所有成年患者。通过查阅病历，分析与真菌感染相关的患者人口统计学数据、预后因素和 30 天死亡率。
研究共纳入 39 例患者。总的死亡率为 35.9%。最常见的分离株是白色念珠菌（82.5%）。主要的预后因素是手术干预次数、革兰氏阴性菌血症、高急性生理与慢性健康评分（APACHE）Ⅱ评分、皮质类固醇的使用以及随后的念珠菌感染（p<0.05）。
在有阳性腹腔内念珠菌培养的患者中，手术干预次数较多、革兰氏阴性杆菌菌血症和高 APACHE Ⅱ评分是死亡的预后因素。皮质类固醇的使用可能是随后发生念珠菌感染的危险因素。
