Effect of early screening for invasive fungal infections in U.S. service members with explosive blast injuries.
Effect of early screening for invasive fungal infections in U.S. service members with explosive blast injuries.
复制标题
对患有爆炸伤的美国军人进行早期侵袭性真菌感染筛查的效果。
DOI：
10.1089/sur.2012.245
复制
发表时间：
2014
影响因子：
2
通讯作者：
Carson,MLei
中科院分区：
文献类型：
--
作者：
Lloyd,Bradley;Weintrob,AmyC;Rodriguez,Carlos;Dunne,JamesR;Weisbrod,AllisonB;Hinkle,Mary;Warkentien,Tyler;Murray,ClintonK;Oh,John;Millar,EugeneV;Shah,Jinesh;Shaikh,Faraz;Gregg,Stacie;Lloyd,Gina;Stevens,Julie;Carson,MLei
背景：侵袭性真菌感染（IFI）的爆发始于2009年在阿富汗遭受爆炸伤的美国军人中。作为回应，军事创伤社区寻求统一的早期诊断和治疗方法。为了实现这一目标，当地的临床实践指南（CPG）实施在兰施图尔地区医疗中心（LRMC）在2011年初筛选IFI的高危患者使用组织病理学和真菌culture.Methods：我们比较了IFI的情况下，启动后的CPG（2011年2月至8月）的情况下，从一个前CPG期间（2009年6月至2011年1月）。两个研究期间的人口统计学特征相似，尽管显著更高的输血需求（p<0.05）和损伤严重程度评分和早期下肢截肢率的非显著趋势表明CPG期病例中更严重的损伤。在组织病理学上，CPG前IFI病例比CPG IFI病例更可能与血管浸润相关（48%对17%; p<0.001）。在CPG期间，IFI诊断时间（3天与9天）和开始抗真菌治疗时间（7天与14天）显著缩短（p<0.001）。此外，CPG期间（30%）与CPG前（5%; p=0.005）相比，更多的IFI患者在LRMC接受抗真菌药物治疗。CPG IFI病例也更常接受双联抗真菌治疗（73% vs 36%; p=0.002）。有没有统计学差异的住院时间或死亡率之间的前CPG和CPG IFI的情况下，虽然一个非显着减少粗死亡率从11.4%到6.7%observed.Conclusions：血管侵袭性IFI作为总IFI病例的百分比下降在CPG期间。实现了早期诊断和更及时的治疗。尽管有这些改善，但与CPG前相比，未观察到临床结局差异。
Background:An outbreak of invasive fungal infections (IFI) began in 2009 among United States servicemen who sustained blast injuries in Afghanistan. In response, the military trauma community sought a uniform approach to early diagnosis and treatment. Toward this goal, a local clinical practice guideline (CPG) was implemented at Landstuhl Regional Medical Center (LRMC) in early 2011 to screen for IFI in high-risk patients using tissue histopathology and fungal cultures.Methods:We compared IFI cases identified after initiation of the CPG (February through August 2011) to cases from a pre-CPG period (June 2009 through January 2011).Results:Sixty-one patients were screened in the CPG period, among whom 30 IFI cases were identified and compared with 44 pre-CPG IFI cases. Demographics between the two study periods were similar, although significantly higher transfusion requirements (p<0.05) and non-significant trends in injury severity scores and early lower extremity amputation rates suggested more severe injuries in CPG-period cases. Pre-CPG IFI cases were more likely to be associated with angioinvasion on histopathology than CPG IFI cases (48% versus 17%; p<0.001). Time to IFI diagnosis (three versus nine days) and to initiation of antifungal therapy (seven versus 14 days) were significantly decreased in the CPG period (p<0.001). Additionally, more IFI patients received antifungal agent at LRMC during the CPG period (30%) versus pre-CPG period (5%; p=0.005). The CPG IFI cases were also prescribed more commonly dual antifungal therapy (73% versus 36%; p=0.002). There was no statistical difference in length of stay or mortality between pre-CPG and CPG IFI cases; although a non-significant reduction in crude mortality from 11.4% to 6.7% was observed.Conclusions:Angioinvasive IFI as a percentage of total IFI cases decreased during the CPG period. Earlier diagnosis and commencement of more timely treatment was achieved. Despite these improvements, no difference in clinical outcomes was observed compared with the pre-CPG period.