关于危重患者中新出现的侵袭性真菌感染(EIFIs)的综合数据很少。我们进行了一项病例对照研究,以描述2006年至2019年法国医学ICU教学医院收治的患者的EIFIs。在6900名患者中,26(每1000人中有4人)有EFI:Mucorales占一半,和其他分离物主要是刺毛菌,镰刀菌和头孢孢子菌。EIFIs主要发生在免疫抑制和严重危重病患者中。几乎所有患者都接受了抗真菌治疗(主要是两性霉素B),而只有19%的人接受了手术。在ICU,死亡率很高(77%),并且与以前的疾病有关,如血液系统恶性肿瘤或癌症,营养不良,慢性肾脏疾病和急性呼吸窘迫综合征和/或肝功能障碍的发生。90天生存率,通过Kaplan-Meier方法计算,EIFIs患者和曲霉病患者对照组之间相似:20%,95%CI(9-45)与18%,95%CI(8-45)(对数秩:p>0.99)。此类患者的ICU管理应根据基本情况进行评估,可逆性和急性事件严重程度,而不是霉菌种类。
Comprehensive data on emerging invasive fungal infections (EIFIs) in the critically ill are scarce. We conducted a case-control
study to characterize EIFIs in patients admitted to a French medical ICU teaching hospital from 2006 to 2019. Among 6900 patients, 26 (4 per 1000) had an EIFI: Mucorales accounted for half, and other isolates were mainly Saprochaete, Fusarium and Scedosporium. EIFIs occurred mostly in patients with immunosuppression and severe critical illness. Antifungal treatments (mainly amphotericin B) were administered to almost all patients, whereas only 19% had surgery. In-ICU, mortality was high (77%) and associated with previous conditions such as hematological malignancy or cancer, malnutrition, chronic kidney disease and occurrence of acute respiratory distress syndrome and/or hepatic dysfunction. Day-90 survival rates, calculated by the Kaplan-Meier method, were similar between patients with EIFIs and a control group of patients with aspergillosis: 20%, 95% CI (9- 45) versus 18%, 95% CI (8- 45) (log-rank: p > 0.99). ICU management of such patients should be assessed on the basis of underlying conditions, reversibility and acute event severity rather than the mold species.