A Clinical Study On The Patients With Combination Sepsis Complicated With Fungi

Objective: (1) To identify the variation of pathogens in ICU leading to sepsis. (2)To explore the risk factors of patients with sepsis causing by the combination of fungiand bacteria. (3) To detect the serum levels ofβ-Glucan, LPS, TNF-α, HLA-DRamong the patients of combination sepsis(means fungi and bacteria)and simplesepsis(bacteria sepsis)and analyze the relationship among these cytokines.Methods: 73 patients with sepsis were studied. 23 healthy volunteers were alsostudied. The patients were divided into two groups: bacteria group(n=44), fungi andbacteria group(n=29). To record and compare their clinical characteristics such as sex,age, outcome from ICU, time stay in ICU, the category and number of fungi andbacteria that affected every patient, sites of infection, the category and quantity ofantibiotics used in patients, paracentesis of deep vein, the APACHE II score recordedin the first 24 hours of ICU admission. Summarize the clinical characteristics ofpatients with combination sepsis. 10ml blood was drawn from every patient's brachialvein on the antibrachium on the day when the patients were admitted to ICU, whilethe controllers were at 8 o'clock on the morning. Detecting and comparing the serumlevels ofβ-Glucan, LPS, TNF-α, HLA-DR of all the patients and controllers and theirrelationships with prognosis.Results: (1) The number of pathogens in ICU during Mar 1, 2000-Mar 1, 2002 was343, and Gram-negative bacteria accounted for 65.01％, Gram-positive bacteria for29.45％and fungi for 5.54％, while the number of pathogens in ICU during Mar 1,2004-Mar 1, 2006 was 246, and Gram-negative bacteria accounted for 52.03％,Gram-positive bacteria for 35.36％and fungi for 12.60％. (2) Fungi and bacteriagroup had the clinical characteristics including longer staying in ICU, higher APACHEⅡscores, more failure organs, longer time that using antibiotics, moreoperations, higher frequency using ventilators, higher morbility comparing with thebacteria group. (3) The serum levels of LPS, TNF-α,β-Glucan of fungi and bacteriagroup were higher than that of bacteria group(p＜0.05). While the expression ofHLA-DR was lower (p＜0.05). (4) When the serum level ofβ-Glucan of fungi andbacteria group increased, the serum levels of LPS, TNF-αincreased, but the HLA-DRreduced.Conclusions: (1) The pathogens in our ICU were still Gram-negative bacteriamainly, but Gram-positive bacteria and fungi increased. (2) Fungi and bacteria grouphad the clinical characteristics including longer staying in ICU, higher APACHEⅡscores, more failure organs, longer time that using antibiotics, more operations,higher frequency using ventilators, higher morbility comparing with the bacteriagroup. (3)β-Glucan as a diagnostic adjunct for invasive fungal infections. (4)β-Glucan and LPS had a synergistic effects on TNF-αproduction .Progressiveincrease in serum level ofβ-Glucan, TNF-α, intensity of the HLA-DR expressiorindicated poor prognosis for patients with sepsis.