| ObjectiveIn recent years, the morbidity and mortality of invasive fungal infections(IFI) is becoming one of the important causes of death in elderly patients because of the increasing aging population and continuous progress of medical treatment technology broad-spectrum antibiotics, corticosteroids, immunosuppressants and invise application of traumatic operation in clinical. Infection with Candida albicans infection strain type still dominated, but its incidence has decreased, while the non Candida albicans proportion increased year by year. At present for the treatment of fungal infections of the main drug divides into pyrrodiazole includes fluconazole itraconazole and voriconazole, polyenes includes amphotericin B and nystatin, echinocandins includes caspofungin, micafungin and so on; Voriconazole is a new synthetic pyrrodiazole antifungal drug which based on the structure of fluconazole, has the characteristics of wide antifungal spectrum, strong antibacterial effects, good clinical efficacy, less side effects etc. The observation of elderly patients with voriconazole therapy is effective and safe of invasivefungal infections.MethodRetrospective investigated elderly patients with invasive fungal infection and voriconazole of General Hospital Affiliated to Tianjin Medical University Department fgeriatrics in April 2013 to April 2014. First, by collecting and analyzing general situations, such as ages, genders, other basic diseases and related treatments before confirming the fungal infection of 24 cases. Second, the statistics of each patient before treatment, the number of species of fungi in the detection, and the application of voriconazole therapy on fungal clearance rate are calculated. Third, by comparing the temperature, accompanied symptoms of all the patients before and after the use of drugs. And counting the fungal clearance rate, total efficiency of elderly patients when using voriconazole treated the invasive fungal infection. At last, observating the occurrence of visual impairment rash, abdominal pain, diarrhea and mental disorders(such as hallucinations, psychosis) and other common adverse reactions when using voriconazole. And statistical analying the indicators of platelet, liver and kidneyfunction, to evaluate the safety of voriconazole in elderly patients.Results1.There are 18 males, 6 females of 24 patients with cases. The age span between 81 to 98 years old, with a median age of 85 years. All patients were complicated with at least basic diseases including diabetes, lung disease, cardiovascular system and nervous system diseases, chronic renal insufficiency, liver disfunction, malignant tumors. There are 16 cases have one to four different bacteria infection. All patients have using broad-spectrum antibioticsfor more than 3 days before the diagnosis of fungal infections. And using fluconazole before voriconazole treatment.2. Among 24 cases, 17 strains of fungi were white, 4 strains of yeast, accounted for 23.5%, 3 strains of Candida glabrata, Candida tropicalis accounted for 17.6%, 4 strains, accounting for 23.5%, 4 strains of Candida parapsilosis, accounted for 23.5%, 1 strains of Candida Lauren ladder in paper, accounted for 5.9%, smooth ball to be false silk yeast 1 strains, accounting for 5.9%, the total clearance rate of fungi was 65%.3.There are 6 cases of confirmed cases, suspected cases of 8 cases, treatment experience of 10 cases, the detection of fungi including parts of 5 cases of pulmonary infection, 4 cases of urinary tract infection, 2 cases of venous cathete infection, 2 cases of pulmonary venous catheter infection, urinary tract and blood infection in 2 cases. After treatment, 5 cases were cured(20.8%), 9 cases(37.5%), 4 cases of progress(16.7%), invalid in 6 cases(25%), the total efficiency of treatment(58.3%). After using the drugs for 3 days, the temperature and symptoms are relicved.4. There was no significant difference with patients before and after treatment, AST, ALT. urea nitrogen and creatinine were compared to liver and kidney function(P> 0.05). During the treatment, 2 patients occured liver and kidney function deterioration, and ultimately death; 1 cases of patients with normal renal function with voriconazole after a transient increase inserum creatinine.Conclusion1. The incidence of fungal infection is higher and more severe in the elderly patients.2. Candida infection of pathogenic bacteria infection is still the main fungi of the detection rate of 24 fungi.3. Voriconazole is effective in elderly patients.4. In the case of testing liver and kidney function, the use of voriconazole in invasive fungal infection is more safe. |
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