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[2005年至2015年期间,智利圣地亚哥一家大学医院丝状真菌引起的侵袭性真菌病流行病学]

[Epidemiology of invasive fungal disease by filamentous fungi in the period 2005 to 2015, in a university hospital in Santiago, Chile].

作者信息

Valenzuela Pablo, Legarraga Paulette, Rabagliati Ricardo

机构信息

Departamento de Enfermedades Infecciosas del Adulto, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

出版信息

Rev Chilena Infectol. 2019 Dec;36(6):732-741. doi: 10.4067/S0716-10182019000600732.

Abstract

BACKGROUND

Invasive fungal disease (IFD) due to filamentous fungi is increasingly common.

AIM

To study the epidemiology of EFI in hospitalized adults in our center.

METHODS

Retrospective study of adult patients of a university hospital in Santiago, Chile, with EFI due to filamentous fungi between January 2005 and December 2015.

RESULTS

125 episodes were identified, being 48% proven, 40% probable and 11% possible according to EORTC/MSG criteria, overall incidence was 0.47/1,000 admissions, 57% male patients and age 50 ± 16 years. 66.4% had hematological pathology, 11.2% solid organ transplant, 11.2% rheumatology diseases, 11.2% other conditions. The risk factors were neutropenia 44%, corticosteroid therapy 21%, immunosuppressants 13%. The most frequent mould identified were Aspergillus spp (53.6%), Mucorales (16%), Fusarium spp (8.8%), Alternaria spp (5.6%) and other filamentous (3.2%). All received antifungals, 82% monotherapy, 18% combined therapy, there was surgical defocation in 90% of mucormycosis. The overall mortality was 42%. When comparing 2005-2009 vs 2010-2015, there was a significant increase in incidence and a tendency to lower mortality in the second period.

CONCLUSIONS

Over a period of 10 years, we observed an increase in the incidence of EFI by filamentous, aspergillosis was the most frequent etiology and the overall mortality was 42%.

摘要

背景

由丝状真菌引起的侵袭性真菌病(IFD)日益常见。

目的

研究我院住院成人患者中丝状真菌引起的侵袭性真菌病(EFI)的流行病学。

方法

对智利圣地亚哥一家大学医院2005年1月至2015年12月期间因丝状真菌引起EFI的成年患者进行回顾性研究。

结果

共识别出125例病例,根据欧洲癌症研究与治疗组织/美国国立医学研究院(EORTC/MSG)标准,确诊病例占48%,很可能病例占40%,可能病例占11%,总体发病率为0.47/1000例住院患者,男性患者占57%,年龄为50±16岁。66.4%的患者有血液学病变,11.2%为实体器官移植患者,11.2%为风湿性疾病患者,11.2%为其他疾病患者。危险因素包括中性粒细胞减少症(44%)、皮质类固醇治疗(21%)、免疫抑制剂(13%)。最常见的霉菌为曲霉属(53.6%)、毛霉目(16%)、镰刀菌属(8.8%)、链格孢属(5.6%)和其他丝状真菌(3.2%)。所有患者均接受了抗真菌治疗,82%为单药治疗,18%为联合治疗,90%的毛霉病患者进行了手术清创。总体死亡率为42%。比较2005 - 2009年和2010 - 2015年,发病率显著增加,且第二期死亡率有下降趋势。

结论

在10年期间,我们观察到丝状真菌引起的EFI发病率增加,曲霉病是最常见的病因,总体死亡率为42%。

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