• 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院呼吸科(北京 100029);

侵襲性真菌感染(IFI)不僅可發(fā)生在惡性血液病、惡性腫瘤、器官移植和AIDS等經(jīng)典免疫功能缺陷患者中，近年來ICU的重癥患者由于嚴(yán)重的基礎(chǔ)疾病、外科手術(shù)指征和范圍的擴(kuò)大、各種導(dǎo)管的體內(nèi)介入與留置，以及廣譜抗生素和糖皮質(zhì)激素的廣泛應(yīng)用等，IFI發(fā)病率也迅速增加。據(jù)統(tǒng)計，IFI占醫(yī)院獲得性感染的8％-15％。IFI病情進(jìn)展快速、兇險，已13益成為導(dǎo)致ICU危重病患者死亡的重要原因之一。引起ICU IFI的病原體包括念珠菌、曲霉、隱球菌、鐮刀霉、接合菌、肺孢子菌等，其中以念珠菌和曲霉最多見，占90％ 以上。由于ICU危重癥患者多數(shù)屬非經(jīng)典IFI高危人群，臨床表現(xiàn)缺乏特異性，臨床診治極為困難。本文就ICU內(nèi)侵襲性念珠菌感染(Ic)和侵襲性曲霉感染(IA)的流行病學(xué)、診斷和治療進(jìn)展進(jìn)行闡述，以期對臨床有所裨益。

引用本文： 劉盛敏,朱光發(fā),梁瑛. 重癥加強(qiáng)治療病房侵襲性真菌感染的臨床研究進(jìn)展. 中國呼吸與危重監(jiān)護(hù)雜志, 2008, 08(6): 477-480. doi: 復(fù)制

1. Ostrosky-Zeichner L，Pappas PG.Invasive candidiasis in the intensive care unit.Crit Care Med，2006，34：857-863.
2. Meersseman W，Lagrou K，Maertens J，et al.Invasive aspergillosis in the intensive care unit.Clin Infect Dis，2007，45：205-216.
3. Vallés J，Mesalles E，Mariscal D，et al.A 7-year study of severe hospital-acquired pneumonia requiring ICU admission.Intensive Care Med，2003，29：1981-1988.
4. Wisplinghoff H，Bischoff T，Tallent SM，et al.Nosocomial bloodstream infections in US hospitals：analysis of 24，179 cases from a prospective nationwide surveillance study.Clin Infect Dis，2004，39：309-317.
5. Lipsett PA.Surgical critical care：fungal infections in surgical patients.Crit Care Med，2006，34（9 Suppl）：S215-S224.
6. Hajjeh RA，Sofair AN，Harrison LH，et al.Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program.J Clin Microbiol，2004，42：1519-1527.
7. Pappas PG，Rex JH，Lee J，et al.A prospective observational study of candidemia：epidemiology，therapy，and influences on mortality in hospitalized adult and pediatric patients.Clin Infect Dis，2003，37：634-643.
8. De Waele JJ，Vogelaers D，Blot S，et al.Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy.Clin Infect Dis，2003，37：208-213.
9. Almirante B，Rodríguez D，Cuenca-Estrella M，et al.Epidemiology，risk factors，and prognosis of Candida parapsilosis bloodstream infections：case-control population-based surveillance study of patients in Barcelona，Spain，from 2002 to 2003.J Clin Microbiol，2006，44：1681-1685.
10. Benjamin DK Jr，Garges H，Steinbach WJ.Candida bloodstream infection in neonates.Semin Perinatol，2003，27：375-383.
11. Perfect JR，Cox GM，Lee JY，et al.The impact of culture isolation of Aspergillus species：a hospital-based survey of aspergillosis.Clin Infect Dis，2001，33：1824-1833.
12. Segal BH，Walsh TJ.Current approaches to diagnosis and treatment of invasive aspergillosis.Am J Respir Crit Care Med，2006，173：707-717.
13. Patterson TF.Advances and challenges in management of invasive mycoses.Lancet，2005，366：1013-1025.
14. 朱小敏，周新.侵襲性肺曲霉病的診斷與治療.中國呼吸與危重監(jiān)護(hù)雜志，2005，4：316-320.
15. Meersseman W，Wingaerden EV.Invasive aspergillosis in the ICU：an emerging disease.Intensive Care Med，2007，33：1679-1681.
16. Meersseman W，Vandecasteele SJ，Wilmer A，et al.Invasive aspergillosis in critically ill patients without malignancy.Am J Respir Crit Care Med，2004，170：621-625.
17. 曹彬，蔡柏薔，王輝，等.肺部真菌感染152例病原譜再評價.中華結(jié)核和呼吸雜志，2007，30：279-283.
18. Hartemink KJ，Paul MA，Spijkstra JJ，et al.Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med，2003，29：2068-2071.
19. Ascioglu S，Rex H，de Pauw B，et al.Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants：An International Consensus.Clin Infect Dis，2002，34：7-14.
20. 中華內(nèi)科雜志編輯委員會.血液病/惡性腫瘤患者侵襲性真菌感染的診斷標(biāo)準(zhǔn)與治療原則.中華內(nèi)科雜志，2005，44：554-556.
21. 中華內(nèi)科雜志編輯委員會.侵襲性肺部真菌感染的診斷標(biāo)準(zhǔn)與治療原則（草案）.中華內(nèi)科雜志，2005，45：697-700.
22. 中華醫(yī)學(xué)會重癥醫(yī)學(xué)分會.重癥患者侵襲性真菌感染診斷與治療指南.中華內(nèi)科雜志，2007，46：960-966.
23. Vandewoude KH，Vogelaers D.Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.Clin Infect Dis，2007，44：380-381.
24. Bulpa P，Dive A，Sibille Y.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.Eur Respir J，2007，30：782-800.
25. Ostrosky-Zeichner L，Rex JH，Bennett J，et al.Deeply invasive candidiasis.Infect Dis Clin North Am，2002，16：821-835.
26. Hope WW，Walsh TJ，Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis，2005，5：609-22.
27. Charles PE，Dalle F，Aube H，et al.Candida spp.colonization significance in critically ill medical patients：a prospective study.Intensive Care Med，2005，31：393-400.
28. Bouza E，Guinea J，Peláez T，et al.Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.J Clin Microbiol，2005，43：2075-2079.
29. Pazos C，Ponto J，DelPalacio A.Contributionof（1，3）-beta-D-glucan chromogenic assay to diagnosisand therapeutic monitoring of invasive aspergillosis in neutropenic adult patients：a comparison with serial screening for circulating galactomannan.J Clinic Microbiol，2005，43：299-305.
30. Odabasi Z，Mattiuzzi G，Estey E，et al.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections：Validation，cutoff development，and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome.Clin Infect Dis，2004，39：199-205.
31. 呂沛華，趙蓓蕾，施毅，等.1，3-β-D葡聚糖檢測診斷侵襲性真菌感染的臨床價值.中華結(jié)核和呼吸雜志，2007，30：31-34.
32. Pfeiffer CD，F(xiàn)ine JP，Safdar N.Diagnosis of invasive aspergillosis using a galactomannan assay：a meta-analysis.Clin Infect Dis，2006，15，42：1417-1427.
33. 朱小敏，周新，蔡逸婷，等.血清半乳甘露聚糖檢測對器官移植術(shù)后侵襲性肺曲霉病的診斷價值.中國抗感染與化療雜志，2005，5：209-211.
34. Meersseman W，Lagrou K，Maertens J，et al.Galactomannan in Bronchoalveolar Lavage Fluid：A Tool for Diagnosing Aspergillosis in Intensive Care Unit Patients.Am J Respir Crit Care Med，2008，177：27-34.
35. Edwards JE Jr，Bodey GP，Bowden RA，et al.International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections.Clin Infect Dis，1997，25：43-59.
36. Piarroux R，Grenouillet P，Balvay V，et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med，2004，32：2443-2449.
37. Pappas PG，Rex JH，Sobel JD，et al.Guidelines for treatment of candidiasis.Clin Infect Dis，2004，38：161-189.
38. Herbrecht R，Denning DW，Patterson TF，et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.N Engl J Med，2002，347：408-415.
  1. 1. Ostrosky-Zeichner L，Pappas PG.Invasive candidiasis in the intensive care unit.Crit Care Med，2006，34：857-863.
  2. 2. Meersseman W，Lagrou K，Maertens J，et al.Invasive aspergillosis in the intensive care unit.Clin Infect Dis，2007，45：205-216.
  3. 3. Vallés J，Mesalles E，Mariscal D，et al.A 7-year study of severe hospital-acquired pneumonia requiring ICU admission.Intensive Care Med，2003，29：1981-1988.
  4. 4. Wisplinghoff H，Bischoff T，Tallent SM，et al.Nosocomial bloodstream infections in US hospitals：analysis of 24，179 cases from a prospective nationwide surveillance study.Clin Infect Dis，2004，39：309-317.
  5. 5. Lipsett PA.Surgical critical care：fungal infections in surgical patients.Crit Care Med，2006，34（9 Suppl）：S215-S224.
  6. 6. Hajjeh RA，Sofair AN，Harrison LH，et al.Incidence of bloodstream infections due to Candida species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a population-based active surveillance program.J Clin Microbiol，2004，42：1519-1527.
  7. 7. Pappas PG，Rex JH，Lee J，et al.A prospective observational study of candidemia：epidemiology，therapy，and influences on mortality in hospitalized adult and pediatric patients.Clin Infect Dis，2003，37：634-643.
  8. 8. De Waele JJ，Vogelaers D，Blot S，et al.Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy.Clin Infect Dis，2003，37：208-213.
  9. 9. Almirante B，Rodríguez D，Cuenca-Estrella M，et al.Epidemiology，risk factors，and prognosis of Candida parapsilosis bloodstream infections：case-control population-based surveillance study of patients in Barcelona，Spain，from 2002 to 2003.J Clin Microbiol，2006，44：1681-1685.
  10. 10. Benjamin DK Jr，Garges H，Steinbach WJ.Candida bloodstream infection in neonates.Semin Perinatol，2003，27：375-383.
  11. 11. Perfect JR，Cox GM，Lee JY，et al.The impact of culture isolation of Aspergillus species：a hospital-based survey of aspergillosis.Clin Infect Dis，2001，33：1824-1833.
  12. 12. Segal BH，Walsh TJ.Current approaches to diagnosis and treatment of invasive aspergillosis.Am J Respir Crit Care Med，2006，173：707-717.
  13. 13. Patterson TF.Advances and challenges in management of invasive mycoses.Lancet，2005，366：1013-1025.
  14. 14. 朱小敏，周新.侵襲性肺曲霉病的診斷與治療.中國呼吸與危重監(jiān)護(hù)雜志，2005，4：316-320.
  15. 15. Meersseman W，Wingaerden EV.Invasive aspergillosis in the ICU：an emerging disease.Intensive Care Med，2007，33：1679-1681.
  16. 16. Meersseman W，Vandecasteele SJ，Wilmer A，et al.Invasive aspergillosis in critically ill patients without malignancy.Am J Respir Crit Care Med，2004，170：621-625.
  17. 17. 曹彬，蔡柏薔，王輝，等.肺部真菌感染152例病原譜再評價.中華結(jié)核和呼吸雜志，2007，30：279-283.
  18. 18. Hartemink KJ，Paul MA，Spijkstra JJ，et al.Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med，2003，29：2068-2071.
  19. 19. Ascioglu S，Rex H，de Pauw B，et al.Defining Opportunistic Invasive Fungal Infections in Immunocompromised Patients with Cancer and Hematopoietic Stem Cell Transplants：An International Consensus.Clin Infect Dis，2002，34：7-14.
  20. 20. 中華內(nèi)科雜志編輯委員會.血液病/惡性腫瘤患者侵襲性真菌感染的診斷標(biāo)準(zhǔn)與治療原則.中華內(nèi)科雜志，2005，44：554-556.
  21. 21. 中華內(nèi)科雜志編輯委員會.侵襲性肺部真菌感染的診斷標(biāo)準(zhǔn)與治療原則（草案）.中華內(nèi)科雜志，2005，45：697-700.
  22. 22. 中華醫(yī)學(xué)會重癥醫(yī)學(xué)分會.重癥患者侵襲性真菌感染診斷與治療指南.中華內(nèi)科雜志，2007，46：960-966.
  23. 23. Vandewoude KH，Vogelaers D.Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.Clin Infect Dis，2007，44：380-381.
  24. 24. Bulpa P，Dive A，Sibille Y.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.Eur Respir J，2007，30：782-800.
  25. 25. Ostrosky-Zeichner L，Rex JH，Bennett J，et al.Deeply invasive candidiasis.Infect Dis Clin North Am，2002，16：821-835.
  26. 26. Hope WW，Walsh TJ，Denning DW.Laboratory diagnosis of invasive aspergillosis.Lancet Infect Dis，2005，5：609-22.
  27. 27. Charles PE，Dalle F，Aube H，et al.Candida spp.colonization significance in critically ill medical patients：a prospective study.Intensive Care Med，2005，31：393-400.
  28. 28. Bouza E，Guinea J，Peláez T，et al.Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital.J Clin Microbiol，2005，43：2075-2079.
  29. 29. Pazos C，Ponto J，DelPalacio A.Contributionof（1，3）-beta-D-glucan chromogenic assay to diagnosisand therapeutic monitoring of invasive aspergillosis in neutropenic adult patients：a comparison with serial screening for circulating galactomannan.J Clinic Microbiol，2005，43：299-305.
  30. 30. Odabasi Z，Mattiuzzi G，Estey E，et al.Beta-D-glucan as a diagnostic adjunct for invasive fungal infections：Validation，cutoff development，and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome.Clin Infect Dis，2004，39：199-205.
  31. 31. 呂沛華，趙蓓蕾，施毅，等.1，3-β-D葡聚糖檢測診斷侵襲性真菌感染的臨床價值.中華結(jié)核和呼吸雜志，2007，30：31-34.
  32. 32. Pfeiffer CD，F(xiàn)ine JP，Safdar N.Diagnosis of invasive aspergillosis using a galactomannan assay：a meta-analysis.Clin Infect Dis，2006，15，42：1417-1427.
  33. 33. 朱小敏，周新，蔡逸婷，等.血清半乳甘露聚糖檢測對器官移植術(shù)后侵襲性肺曲霉病的診斷價值.中國抗感染與化療雜志，2005，5：209-211.
  34. 34. Meersseman W，Lagrou K，Maertens J，et al.Galactomannan in Bronchoalveolar Lavage Fluid：A Tool for Diagnosing Aspergillosis in Intensive Care Unit Patients.Am J Respir Crit Care Med，2008，177：27-34.
  35. 35. Edwards JE Jr，Bodey GP，Bowden RA，et al.International Conference for the Development of a Consensus on the Management and Prevention of Severe Candidal Infections.Clin Infect Dis，1997，25：43-59.
  36. 36. Piarroux R，Grenouillet P，Balvay V，et al.Assessment of preemptive treatment to prevent severe candidiasis in critically ill surgical patients.Crit Care Med，2004，32：2443-2449.
  37. 37. Pappas PG，Rex JH，Sobel JD，et al.Guidelines for treatment of candidiasis.Clin Infect Dis，2004，38：161-189.
  38. 38. Herbrecht R，Denning DW，Patterson TF，et al.Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis.N Engl J Med，2002，347：408-415.

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    驗證治療措施的公平——高質(zhì)量研究促進(jìn)高質(zhì)量衛(wèi)生保健（Ⅷ）