The Prognostic Analysis Of Critically Ill Patients With Fungemia(4Cases Report)

Backgrounds and objections:Fungemia refers to the presence of blood in fungi. With thedevelopment of the modern organ function support technology progress,critically ill patients admitted to ICU time also gradually extended, at thesame time as the various monitoring and treatment method and theextensive application of antibacterial drugs, making the ICU patientssuffering from fungemia incidence is also increasing gradually. In theUnited States, candidemia has grown the fourth in nosocomialblood-borne infection. Fungemia diagnosed basis for the blood culturepositive results, and the blood culture results return time will be at leastfour to seven days, so early diagnosis is difficult. At present, despite thevariety of antifungal drugs have been widely used in clinic, but theprognosis of the patients with fungemia have not been significantlyimproved, the mortality rate is still higher. This paper retrospectivelyanalyzed in our hospital from2010to2012,14cases of deep fungalinfections in critically ill patients, who APACHE Ⅱ score were between20-30points, including4cases of the blood culture confirmed fungemia,and the other10cases of confirmed deep fungus infection patients thatsputum culture or urine culture fungi is positive,and the blood culturefungi is negative,discuss ICU fungemia in patients with underlyingdiseases, risk factors, clinical features, treatment and prognosis, furtherunderstanding of fungemia in development process, in order to improvethe prognosis of critically ill patients with fungemia, reduce the mortalityrate.Research Methods: 14cases of critically ill patients admitted to icu of our hospital fromfebruary in2010to february in2012by clinical characteristics andmicrobiology examination (blood culture,sputum cultures, urine culture)confirmed deep fungal infections,who APACHE Ⅱs core werebetween20-30points, based on blood culture fungi results grouped, group A: afterICU4cases of the blood culture confirmed fungemia; group B: afterICU10cases of confirmed deep fungus infection patients that sputumculture or urine culture fungi is positive,and the blood culture fungi isnegative.Collection of patient age,history of chronic diseases andadmitted to the hospital first days of patient’s bodytemperature,respiratory rate,heart rate, mean arterial pressure,Glasgowcoma scale,arterial oxygen partial pressure,alveolar arterial oxygen partialpressure,pH value,serum sodium, serum potassium,serumcreatinine,hematocrit,white blood cell count,platelet count,and the resultsof blood culture,urine culture,sputum culture(who transferred out of ICUor discharged are live;who died or with abandonment of treatment andrescue during hospitalization in ICU), using the SPSS13.0statisticalsoftware package processing, analysis of A, B group patients whetherexist statistical difference in age, sex, underlying diseases after icu,mortality rate, meanwhile, observation of fungemia in patients withunderlying diseases, risk factors, diagnosis, treatment and prognosis.Results:1. the statistical analysis of A, B group patients have no significantstatistically difference in age, sex, underlying diseases after icu (P>0.05);2.the group A: four patients,3cases of death; Group B:10patients,1case of death, there is significant statistically difference between the two groups in mortality rate after statistics correction chi-square analysis (p<0.05);3.This material, fungemia in patients with underlying diseasesmainly included perinatal pathology obstetrics, severe pancreatitis, severepulmonary infection, shock, liver and kidney damage and multiple organdysfunction, cerebral vascular accident, pituitary crisis, thyroiddysfunction, and each patient was for multiple systems involvement,APACHE II score for22~30points. A variety of invasive diagnosticmeasures(including deep venous catheter, blood purificationtherapy,parenteral nutrition, tracheal intubation/tracheotomy operationmechanical ventilation, a variety of drainage pipes etc), the extensiveapplication of antibacterial drugs, accompanied by multiple systemsinvolvement are the high risk factors of the critically ill patients withfungemia in icu. Clinical diagnosis of fungemia often is often based onritically ill patients wether exist underlying diseases, risk factors to getfungal disease, clinical features, blood culture and comprehensivejudgment, of which the blood culture fungi positive is the basis ofdiagnosis.The blood culture fungi species is Candida, includingsaccharomyces albicans in2cases, smooth candida yeast in1, and g softcandida yeast in1. The treatment of antifungal drugs prevention treatmentand targeted therapy,1case were cured,3cases due to the criticalcondition of the patient, complicated by multiple system injury death.Conclusions:1.Lead to multiple systems involvement of the diseases are thecommon disease of fungemia in ICU.2.A variety of invasive diagnostic measures and the extensiveapplication of antibacterial drugs are the high risk factors of the criticallyill patients with fungemia in ICU. 3.Empirical therapy for early selection of broad-spectrum antifungaldrugs,targeting therapy of antifungal drugs in sufficient quantity, longperiod of treatment is the key to the success of the rescue.4.When critically ill patients reached a considerable degree(APACHE Ⅱ scores in the20-30), fungemia in patients with a highermortality rate.