Impact of invasive fungal infection on outcomes of severe sepsis: a multicenter matched cohort study in critically ill surgical patients

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• 作者：Guo-Hao Xie (1)
  Xiang-Ming Fang (1)
  Qiang Fang (1)
  Xin-Min Wu (2)
  Yu-Hong Jin (3)
  Jun-Lu Wang (4)
  Qu-Lian Guo (5)
  Miao-Ning Gu (6)
  Qiu-Ping Xu (7)
  Dong-Xin Wang (2)
  Shang-Long Yao (8)
  Shi-Ying Yuan (8)
  Zhao-Hui Du (9)
  Yun-Bo Sun (10)
  Hai-Hong Wang (7)
  Shui-Jing Wu (1)
  Bao-Li Cheng (1)
  
• 刊名：Critical Care
• 出版年：2008
• 出版时间：February 2008
• 年：2008
• 卷：12
• 期：1
• 全文大小：
• 作者单位：Guo-Hao Xie (1)
  Xiang-Ming Fang (1)
  Qiang Fang (1)
  Xin-Min Wu (2)
  Yu-Hong Jin (3)
  Jun-Lu Wang (4)
  Qu-Lian Guo (5)
  Miao-Ning Gu (6)
  Qiu-Ping Xu (7)
  Dong-Xin Wang (2)
  Shang-Long Yao (8)
  Shi-Ying Yuan (8)
  Zhao-Hui Du (9)
  Yun-Bo Sun (10)
  Hai-Hong Wang (7)
  Shui-Jing Wu (1)
  Bao-Li Cheng (1)
  
  1. Department of Anesthesiology and Intensive Care Unit, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, 310003, Hangzhou, China
  2. Department of Anesthesiology and Intensive Care Unit, the First Affiliated Hospital, School of Medicine, Peking University, 8 West Shenku Avenue, 100034, Beijing, China
  3. Intensive Care Unit, Lihuili Hospital, School of Medicine, Ningbo University, 57 Xingning Road, 315040, Ningbo, China
  4. Department of Anesthesiology, the First Affiliated Hospital, Wenzhou Medical College, 2 Fuxue Road, 325000, Wenzhou, China
  5. Department of Anesthesiology and Intensive Care Unit, Xiangya Hospital, Xiangya Medical College, Central South University, 87 Xiangya Road, 410008, Changsha, China
  6. Department of Anesthesiology and Intensive Care Unit, South Hospital, South Medical University, 1836 Guangzhou Road, 510515, Guangzhou, China
  7. Department of Anesthesiology and Intensive Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun Road, 310016, Hangzhou, China
  8. Department of Anesthesiology and Intensive Care Unit, Union Hospital, Tongji Medicine College, Huazhong University of Science and Technology, 1095 Jiefang Road, 430030, Wuhan, China
  9. Intensive Care Unit, Zhongnan Hospital, School of Medicine, Wuhan University, 169 Donghu Road, 430071, Wuhan, China
  10. Department of Anesthesiology and Intensive Care Unit, Qingdao University Hospital, School of Medicine, Qingdao University, 16 Jiangsu Road, 266011, Qingdao, China
  
• ISSN：1364-8535

文摘

Introduction Fungal infection is increasingly common in critical illness with severe sepsis, but the influence of invasive fungal infection (IFI) on severe sepsis is not well understood. The aim of this study was to investigate the impact that IFI has on the outcomes of critically ill surgical patients with severe sepsis in China by means of matched cohort analysis; we also evaluated the epidemiologic characteristics of IFI in this population. Methods Records for all admissions to 10 university hospital surgical intensive care units (ICUs) from December 2004 to November 2005 were reviewed. Patients who met criteria for severe sepsis were included. IFI was identified using established criteria based on microbiologic or histological evidence. A matched cohort study was conducted to analyze the relationship between IFI and outcomes of severe sepsis. Results A total of 318 patients with severe sepsis were enrolled during the study period, of whom 90 (28.3%) were identified as having IFI. A total of 100 strains of fungi (58% Candida albicans) were isolated from these patients. Independent risk factors for IFI in patients with severe sepsis included mechanical ventilation (>3 days), Acute Physiology and Chronic Health Evaluation score, coexisting infection with both Gram-positive and Gram-negative bacteria, and urethral catheterization (>3 days). Compared with the control cohort, IFI was associated with increased hospital mortality (P < 0.001), high hospital costs (P = 0.038), and prolonged stay in the ICU (P < 0.001) and hospital (P = 0.020). Conclusion IFI is frequent in patients with severe sepsis in surgical ICUs and is associated with excess risk for hospital mortality, longer ICU and hospital stays, and greater consumption of medical resources.