Prevalence and outcome of fungal infection in patients with severe acute pancreatitis
Prevalence and outcome of fungal infection in patients with severe acute pancreatitis
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DOI：
10.1111/j.1440-1746.2008.05712.x
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发表时间：
2009-05-01
影响因子：
4.1
通讯作者：
Singh, Kartar
中科院分区：
文献类型：
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作者：
Kochhar, Rakesh;Ahammed, S. K. Mahiuddin;Singh, Kartar
为了研究重症急性胰腺炎患者真菌感染的危险因素和预后，对50例重症急性胰腺炎患者进行了每周一次的体液培养和胰腺/胰周组织穿刺液培养以及坏死组织切除术后收集的样本的真菌感染证据的调查。所有患者均按照标准方案进行管理。有真菌感染记录的患者接受静脉注射阿替霉素或氟康唑治疗。采用SPSS软件（13版）对数据进行分析，确定真菌感染和死亡的危险因素，其中18例（36%）患者的真菌感染为白色念珠菌（最常见的菌种）。真菌感染的发生率随着住院时间的增加而稳步上升。那些真菌感染的人更经常有呼吸衰竭的证据（P = 0.031）和低血压（P = 0.031）入院时，延长住院时间> 4周（P = 0.034），抗生素持续时间较长（P = 0.003）、接受全肠外营养（P = 0.005）和需要机械通气（P = 0.001）。Logistic回归分析发现，真菌感染的独立危险因素是抗生素治疗> 4周和住院时低血压。在18例真菌感染患者中，13例接受了静脉抗真菌药物治疗，其中8例存活，5例未接受抗真菌药物治疗的患者死亡，真菌感染检出率为36%。与之相关的独立危险因素是住院时低血压和长期抗生素治疗。抗真菌治疗提高了他们的生存机会。
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.