在穿孔性胃潰瘍疾病中的抗真菌使用:西澳大利亞的視角
Nikitha Boyapati1, Vidya Willis1, Amanda Foster1
1General Surgery, Fiona Stanley Hospital, Perth, AUS.
Cureus
|March 4, 2024
概括
穿孔性胃潰瘍疾病中的抗真菌使用有所不同. 在非免疫功能低下的患者中,抗真菌药物增加了发病率,而免疫功能低下的患者无论使用抗真菌药物,结果都没有差异.
科学领域:
- 胃肠病学 胃肠病学
- 手术传染病 手术传染病
- 关键护理医学 关键护理医学
背景情况:
- 穿孔性胃潰瘍疾病 (PPU) 的死亡率很高.
- 抗真菌的使用是免疫受损患者的标准,但在其他人中不一致.
- 本研究研究了PPU患者的抗真菌使用模式和结果.
研究的目的:
- 描述目前在西澳大利亚的PPU的抗真菌处方做法.
- 评估接受抗真菌药物治疗的免疫受损和非免疫受损PPU患者的外科期发病率和死亡率.
主要方法:
- 在西澳大利亚三级医院 (2010-2017) 进行手术修复的359名PPU患者的回顾性审查.
- 收集的数据包括手术前的因素 (年龄,并发症,ASA得分),手术后的结果 (败血症,出血),抗真菌处方和真菌生长.
- 分析对免疫受损和非免疫受损队列之间的结果进行了比较,使用或不使用抗真菌药物.
主要成果:
- 抗真菌的处方有很大的差异.
- 美国麻醉学会 (ASA) 的较高分数 (≥3),手术前的休克,酸性疾病和丰富的真菌生长预测了抗真菌处方.
- 接受抗真菌药物治疗的非免疫功能低下患者患病率较高,与未接受抗真菌药物治疗的患者相比.
- 根据抗真菌药物的使用,在免疫功能低下的患者中没有观察到发病率或死亡率的显著差异.
结论:
- 在PPU中使用的抗真菌药物是可变的,受患者因素和真菌负载的影响.
- 在非免疫功能受损的PPU患者中,抗真菌药物治疗与增加的发病率有关.
- 目前的证据不支持在非免疫功能低下的PPU患者中常规使用抗真菌药物.
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