真菌性脓毒症诊治进展学案.ppt

安徽省立医院 重症医学科 周树生 Email:zhouss108@163.com /bbs * 确诊导管相关性念珠菌血症平均TTP为17.3h，显著性短于非导管相关性念珠菌血症38.2h （P 0.001） 。取折点为30h时，敏感度和特异度分别为100%和51.4%。ROC为0.76。 光滑念珠菌TTP显著性长于其他念珠菌， 61.3+7 h 25.6+ 2 h; P 0.001). 8例光滑念珠菌感染有两例在疑诊CRC组，6例在非CRC组。如果排除光滑念珠菌感染的8个病例，CRC组TTP仍然显著性短于非CRC组。 样本量少，观察性研究，采血量未作质控。 2010.7-2011.3国立台湾大学医院对329份血培养阳性标本进行检测， TTP由自动血培养仪测定。光滑念珠菌TTP显著性长于其他三种念珠菌。热带念珠菌TTP在四种念珠菌中最短。 如果TTP24.7h，光滑或克柔念珠菌的可能性最小。敏感度97.1%，特异度58.9%，阳性预测值36.6%，阴性预测值98.8%。 北美105家医院随机双盲多中心队列研究 * * * * 时间：2009.11.1- 2011.4.30 参加单位：63家医院，67个ICU 研究目的：了解ICU患者侵袭性念珠菌感染发病情况、患者特征 ,药敏情况,诊断和治疗现状 菌株数：同例患者培养出相同菌种多株，仅算一株；一例患者标本中分离到2种不同念珠菌算2种； 共报告分离出321株致病菌，白念占43%（139株），但有19株未报告具体名称，可能包含白念，需等中心实验室确认。 《美国呼吸与危重医学杂志》 Int J Antimicrob Agents.?2009?Sep;34(3):205-9 Consensus statement on the management of invasive candidiasis in ICU in the Asia-Pacific Region CHINA SCAN team Non albicans 54.7% C. albicans 41.8% mixed infection other Candida species Diagnostic confirmation was based solely on at least one positive blood culture in 290 (94.8%) cases Diagnosis was confirmed by histopathology in one patient (0.3%) Invasive candidiasis in intensive care units in China: a multicentre prospective observational study. J Antimicrob Chemother.2013 Mar 29.1-9 Fengmei Guo1,Yi Yang1, Yan Kang,et al. Crit Care. 2008;12(1):R5 Impact of invasive fungal infection on outcomes of severe sepsis: a mul-ticenter matched cohort study in critically ill surgical patients Outcomes of candidemic septic shock patients compared with bacteremic septic shock patients Crit Care Med. 2002 Aug;30(8):1808-14. International Guidelines for Management of Severe Sepsis and Septic Shock: 2012 what actually changed about fungus? Use of the 1,3 beta-D-glucan assay (grade 2B), mannan and anti-mannan antibody assays (2C). Change 1:Diagnosis Intern Med.?2011;50(22):2783-91 Diagnosis of invasive fungal disease using serum (1→3)-β-D-glucan: a bivariate meta-analysis. NOTE. AUC, the area under the summary receiver operating characteristic curve; CI