The clinical monitoring of invasive aspergillosis in surgical intensive care unit during 10 years / 中华危重病急救医学

ABSTRACT

Objective To investigate the invasive aspergillosis (IA) status in a surgical intensive care unit (SICU).Methods The clinical data including general state,operation,pathogenic microorganisms,infection position,clinical situation,treatment and prognosis of patients with IA admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were retrospectively analyzed.Results 8 220 patients admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were enrolled.Of 8 220 patients,there were 29 cases experienced IA,with an incidence of 0.35％,and the incidence of hospital onset of IA infection was 0.27％ (22/8 220).The incidence of hospital onset of IA infection was accounted for 6.98％ (22/315) of the incidence of hospital onset of infection in SICU in the same period.Compared with 2004-2008,in 2009-2013,the incidence of hospital onset of infection was significantly decreased [3.19％ (137/4 293) vs.4.53％ (178/3 927),x2=10.020,P=0.002],while the incidence of IA [0.56％ (24/4 293) vs.0.13％ (5/3 927),x2=10.874,P=0.001],the incidence of hospital onset of IA infection [0.40％ (17/4 293) vs.0.13％ (5/3 927),x2=5.556,P=0.019],and the percentage of incidence of hospital onset of IA infection according to the incidence of hospital onset of infection were increased by 5 years [12.40％ (17/137) vs.2.81％ (5/178),x2=10.982,P=0.001].Of 29 patients with IA,25 cases had occurred after operation,and the majority of them were from the Department of General Surgery (13 cases),and followed by post-renal transplantation (6 cases) and post-thoracic surgery (3 cases).In the total submission of 155 specimens from 29 patients with IA,there were 17 strains isolated aspergillosis,among which included 2 strains of Aspergillus fumigatus,and 15 other un-subgrouped strains.The most common infection site was lower respiratory tract (23 cases,79.31％).Sixteen patients were found with positive galactomannan (GM) test.In all the risk factors contributing to IA,the ratio of the long-term usage of broad-spectrum antibiotics over 4 days was the highest [36.25％ (29/80)],which followed by the long-term use of hormone [18.75％ (15/80)],complicated with acute kidney injury [18.75％ (15/80)],liver injury [13.75％ (11/80)],the long-term use of immunosuppressive orally [7.50％ (6/18)],and complicated with neutropenia [5.00％ (4/80)].In 29 patients with IA,there were 28 patients received anti-fungal treatment except for 1 patient without treatment,and those were single use of itraconazole in 1 case,single use of echinocandins in 3 cases,single use of liposomal amphotericin B in 5 cases,8 cases with voriconazole,single use of liposomal amphotericin B or echinocandins then replaced by voriconazole in 8 cases,and 3 cases of echinocandins therapy combined with voriconazole.Seventeen of 29 patients died,with a mortality rate of 58.62％.Conclusions IA is an uncommon but increasing postoperative complication of patients in SICU in recent 5 years.The most common sites of IA were lower respiratory tract.The mortality of IA is very high.So clinicians should pay more attention to the careful monitor for IA.