不同真菌感染对肝衰竭患者病情及预后影响的研究

目的 探讨不同真菌感染对肝衰竭患者病情及预后的影响.方法 回顾性分析我院感染科近5年内收治的80例肝衰竭患者的完整临床资料.分析不同真菌感染对患者病情及转归的影响.观察患者真菌数量、种类及构成情况、患者真菌感染部位及构成情况及不同类型真菌感染患者的治疗与转归情况.结果 ①80例患者中共分离出真菌80株,其中白色假丝酵母菌占52.50%(42/80)(该菌占比最大),热带假丝酵母菌占10.00%(8/80),光滑假丝酵母菌、克柔假丝酵母菌均占7.50%(6/80),烟曲霉菌、未分类曲霉菌均占6.25%(5/80),黄曲霉菌属占5.00%(4/80),青霉菌属、毛霉菌属均占2.50%(2/80).②80株真菌中,口腔感染占43.75%(35/80),呼吸道感染占20.00%(16/80),血液感染占15.00%(12/80),肠道、泌尿道感染各占8.75%(7/80),腹腔感染占3.75%(3/80).③80例患者均给予基础肝病治疗,联合伏立康唑、氟康唑、卡泊芬净、两性霉素B及伊曲康唑抗真菌治疗.80例患者中,死亡率由高到低依次为毛霉菌属100%(2/2)、曲霉菌属57.15%(8/14)、青霉菌属50.00%(1/2)、酵母菌属(白色假丝酵母菌为主)24.19%(15/62);毛霉菌属感染者病死率最高,预后最差,酵母菌感染(白色假丝酵母菌为主)者病死率最低,预后最好;4组病死率比较,差异有统计学意义(P<0.05).     

广州市胸科医院结核重症监护室患者常见病原菌分布及耐药性分析

目的分析广州市胸科医院结核重症监护室(ICU)患者常见病原菌的分布及耐药情况,为重症感染患者的初始经验性用药提供临床依据。方法回顾性分析2018年ICU患者送检标本培养出的病原学分布情况及多重耐药菌的药敏结果。结果1、共检出病原菌599株,包括细菌433株,其中多重耐药菌占比72.75%(315株);真菌166株,主要为热带假丝酵母菌(31.33%)、光滑假丝酵母菌(28.31%)及曲霉菌(10.84%)。2、临床检出的315株多重耐药菌中,革兰阴性杆菌占87.62%,其中鲍曼不动杆菌占44.76%,肺炎克雷伯杆菌占23.81%,铜绿假单胞菌占10.79%;革兰阳性球菌占12.38%,其中表皮葡萄球菌占2.86%,溶血葡萄球菌占2.54%,屎肠球菌占2.22%,金黄色葡萄球菌占1.27%。3、临床分离的革兰阴性杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、左氧氟沙星、亚胺培南的耐药情况严重,对替加环素、妥布霉素、阿米卡星的耐药性相对较低,未发现耐黏菌素菌株;革兰阳性球菌总体对头孢洛林、利奈唑胺、万古霉素、替考拉宁、替加环素、达托霉素的敏感性较好。结论结核重症监护室检出的病原菌以多重耐药菌及真菌常见,经验性用药需考虑耐药分布情况及真菌感染的可能性。     

COPD患者并发真菌感染的临床特点、危险因素及治疗效果分析

目的探讨慢性阻塞性肺疾病(COPD)患者并发真菌感染的临床特点、危险因素和治疗效果。方法临床确诊COPD患者438例,采集血液、尿液、痰液、粪便等标本进行真菌培养检查,分析真菌感染发生率,感染部位、感染真菌种类及构成情况;调查COPD患者的相关临床资料,通过多因素Logistic回归分析法分析并发真菌感染的危险因素。对真菌感染者进行相应抗真菌治疗,观察治疗效果。结果 COPD患者并发真菌感染率为4.34%, 52.63%为呼吸道真菌感染。共检出真菌29株,其中17株(占58.62%)为白色假丝酵母菌。多因素Logistic回归分析法分析显示,侵入性操作、抗生素使用时间≥2周、累计使用糖皮质激素500 mg为COPD并发真菌感染的危险因素(均P0.05)。感染真菌的COPD患者给予抗真菌治疗,总有效率为68.42%,不良反应发生率为21.05%。结论呼吸道是COPD患者并发真菌感染的主要部位,白色假丝酵母菌是常见致病性真菌,侵入性操作、长期使用抗生素及过量使用糖皮质激素等为COPD患者发生真菌感染的风险因素,应引起高度重视。     

COPD患者并发真菌感染的临床特点、危险因素及治疗效果分析北大核心CSCD

目的探讨慢性阻塞性肺疾病(COPD)患者并发真菌感染的临床特点、危险因素和治疗效果。方法临床确诊COPD患者438例,采集血液、尿液、痰液、粪便等标本进行真菌培养检查,分析真菌感染发生率,感染部位、感染真菌种类及构成情况;调查COPD患者的相关临床资料,通过多因素Logistic回归分析法分析并发真菌感染的危险因素。对真菌感染者进行相应抗真菌治疗,观察治疗效果。结果 COPD患者并发真菌感染率为4.34%, 52.63%为呼吸道真菌感染。共检出真菌29株,其中17株(占58.62%)为白色假丝酵母菌。多因素Logistic回归分析法分析显示,侵入性操作、抗生素使用时间≥2周、累计使用糖皮质激素>500 mg为COPD并发真菌感染的危险因素(均P<0.05)。感染真菌的COPD患者给予抗真菌治疗,总有效率为68.42%,不良反应发生率为21.05%。结论呼吸道是COPD患者并发真菌感染的主要部位,白色假丝酵母菌是常见致病性真菌,侵入性操作、长期使用抗生素及过量使用糖皮质激素等为COPD患者发生真菌感染的风险因素,应引起高度重视。     

X线平片与CT对HIV肺部感染的诊断价值比较

目的探讨X线平片与CT用于人体免疫缺陷病毒(HIV)并发肺部真菌感染的诊断价值。方法随机抽取2014年7月-2016年7月,60例在我院接受诊断治疗的HIV肺部感染患者资料,对肺部真菌感染进行分组诊断,对照组(X线平片检查)、观察组(CT检查);结合诊断结果,对比2组患者肺部真菌感染的阳性率,对真菌感染者提出科学的治疗方案。结果本次60例肺部真菌感染患者,真菌培养100%阳性,2组诊断结果中,观察组43例阳性,阳性率71.7%,对照组6例阳性,阳性率10%;CT检查明显优越X线平片检查。从真菌分布来看,本次检出60珠真菌,白色假丝酵母菌42例,占70%,热带假丝酵母菌10例、光滑假丝酵母菌6例、毛霉菌属1例、曲霉菌属1例。结论 CT检查用于HIV肺部真菌感染诊断效果更高,为感染症状治疗提供了临床参考依据,值得推广。     

肺部真菌感染42例临床分析

目的对肺部真菌感染的临床特点、诊断及治疗结果进行分析。方法呼吸内科近3年来收治的肺部真菌感染的患者病历资料,包括患者的基础疾病、感染的真菌种类以及治疗结果等进行分析。结果近3年来,共有42例患者诊断为肺部真菌感染。其中,肺孢子菌感染16例(38.10%),白色假丝酵母菌12例(28.57%),曲霉菌感染9例(21.43%),克柔假丝酵母菌1例(2.38%),热带假丝酵母菌1例(2.38%),光滑念珠菌1例(2.38%),奴卡菌1例(2.38%),近平滑假丝酵母菌1例(2.38%)。患者免疫缺陷或机体免疫力低下占32例(76.20%)。结论肺部真菌感染患者多有基础疾病或免疫缺陷,本组患者肺部感染的常见真菌为肺孢子菌,治疗效果与患者基础疾病及免疫状况有关。     

系统性红斑狼疮合并深部真菌感染临床分析

目的 探讨系统性红斑狼疮(SLE)合并深部真菌感染的部位、菌种、诊断及预后.方法 回顾性分析北京协和医院2000-2006年住院治疗的1466例SLE患者中合并深部真菌感染的51例患者的临床资料. 结果 合并深部真菌感染51例SLE患者.感染的病原菌以白色念珠菌为主,其次为隐球菌和曲霉菌.感染最常见的部位是肺,其次为脑膜和血液.本组病例巾死亡10例,病死率达20%.曲霉菌感染者病死率高达4/5.低蛋白血症、多部位真菌感染、曲霉菌感染、真菌血症可能是导致SLE患者死亡的独立危险因素. 结论 SLE合并真菌感染的主要部位为肺,感染的病原菌以白色念珠菌为主;临床应重视早期诊断和曲霉菌感染.     

血液系统肿瘤院内真菌感染的临床分析

目的探讨血液系统肿瘤患者院内真菌感染的现状,分析其危险因素及预防措施。方法对2006年1-12月间经微生物学检查证实的70例血液系统肿瘤合并院内真菌感染患者的临床资料及真菌培养结果进行统计分析。结果真菌感染部位以呼吸道为主(88.57%),胃肠道次之(7.14%);感染菌株以白假丝酵母菌占首位(56.96%),其次为克柔假丝酵母菌(12.66%)、光滑假丝酵母菌(11.39%)。结论本组患者院内真菌感染与原发基础疾病、反复化疗、粒细胞减少、老龄化、广谱抗生素及免疫抑制剂的应用等危险因素密切相关。     

ICU深部真菌感染52例临床分析和防治

目的探讨院内真菌感染的类型及易感因素。方法收集我院ICU2006年10月～2008年10月住院患者确诊为医院感染的各类标本共156株送检。结果156株标本中深部真菌感染52例,占33.3%;分离出的真菌标本中,真菌感染阳性标本前3位分别是痰液、尿液、大便,其中痰液标本阳性有30例(占57.69%);前3位的真菌菌种分别为白色念珠菌、热带念珠菌、光滑球念珠菌,其中白色念珠菌为30例(占57.69%)。结论重症监护病房治疗的患者易发生真菌感染,真菌感染以白色念珠菌为主,感染部位以下呼吸道为主。     

老年真菌性鼻窦炎患者病原菌分布特征及定植高危因素分析

目的探讨老年真菌性鼻窦炎(FRS)患者感染病原菌的分布特征,并分析其定植的高危因素。方法 2019年1月—2021年1月本院收治的老年真菌性鼻窦炎患者149例,所有患者均经直接显微镜检查和病原培养鉴定确诊。149例患者分为真菌定植组和非真菌定植组,分析病原菌菌群感染性别分布及标本取材部位分布情况。收集患者的年龄、性别、吸烟、饮酒、病程、侵入性操作、联合使用抗生素情况、抗生素更换次数、糖皮质激素使用时间、合并症、真菌菌种、发病部位、侵袭性等资料,分析影响老年FRS真菌定植的高危因素。结果 149例老年FRS患者中属于真菌感染81例,真菌定植68例,分别占54.36%和45.67%。检出真菌以黄曲霉菌居多(占42.28%),其次为烟曲霉菌(占32.89%)。检出白色念珠菌4株(占2.68%)。女性患者分离真菌合计占比为65.10%,男性患者分离真菌合计占比为34.90%,差异有统计学意义(P0.05)。真菌分离自上颌窦标本124株(占83.22%),分离自蝶窦标本14株(占9.40%),分离自筛窦标本9株(占6.04%),分离自额窦标本2株(占1.34%),差异有统计学意义(P0.05)。经Logistic回归分析,高龄、侵入性操作、联合使用抗生素、抗生素更换次数≥3次、糖皮质激素使用时间长、存在合并症是影响老年FRS患者真菌定植的独立危险因素(均P0.05)。结论 FRS多发于老年女性群体,以黄曲霉菌为主要致病菌,且好发于上颌窦。采取有效的应对措施,如合理应用抗生素,控制糖皮质激素的使用等可减少老年FRS的发生。     

血清半乳甘露聚糖检测诊断侵袭性肺曲霉病的实验研究

目的评价血清半乳甘露聚糖（GM）检测对侵袭性肺曲霉病（IPA）的诊断价值。方法清洁级健康成年SD大鼠90只，按随机区组设计分为烟曲霉感染组、白假丝酵母菌感染组、毛霉感染组、肺炎链球菌感染组、烟曲霉口咽定植组，每组18只。气管插管滴人法建立大鼠侵袭性肺部真菌感染和细菌感染动物模型。经鼻腔和口咽滴人法建立烟曲霉口咽定植动物模型。分别于接种完成后第3天、第7天、第12天处死大鼠，取心脏血，采用Platelia Aspergillus（法国Bio—Rad公司）试剂盒检测血清GM，取肺组织行组织病理学检查。多组间比较采用单因素方差分析，实验数据经SPSS统计软件处理。结果除曲霉定植组外，光镜下各组大鼠肺组织均见明显炎症反应，真菌感染大鼠在肺组织中可见真菌菌丝或孢子。烟曲霉、白假丝酵母菌、毛霉、肺炎链球菌感染组和烟曲霉口咽定植组大鼠血清GM的吸光度指数均值分别为1．69±0．29、0．89±0．46、0．87±0．39、0．77±0．34和0．90±0．49，烟曲霉感染组与其他4组分别比较，差异明显。以吸光度指数为1．5作为诊断阈值诊断IPA的敏感性、特异性、阳性预测值和阴性预测值分别为78．6％、87．5％、57．9％和94．9％；以吸光度指数为1．5时，第3天、第7天和第12天血清GM检测诊断IPA的敏感性分别为60％、80％和100％。结论GM检测可区分IPA与白假丝酵母菌感染、毛霉感染、肺炎链球菌感染和烟曲霉口咽定植；GM检测诊断IPA的敏感性随感染时间的延长而增加；以吸光度指数为1．5作为诊断阈值诊断IPA的敏感性、特异性较理想。     

Pre-emptive therapy with azoles in lung transplant patients. Geneva Lung Transplantation Group.

Pulmonary fungal infection is diagnosed in up to 15-25% of lung transplant recipients and frequently bears a fatal outcome. This prospective uncontrolled study addresses the efficacy and safety of pre-emptive azole therapy against fungal infection in these patients. Fluconazole or itraconazole have been systematically used according to reported fungus sensitivity after the discovery of fungi in lower respiratory tract samples. Patients were treated until the bronchial suture was normal and the cultures of the following bronchoscopy remained negative. Fungi were found post-transplantation in the lower respiratory tract specimens of 26 out of 31 (84%) patients, predominantly Candida albicans (20 patients) and Aspergillus fumigatus (16 patients). Mycelia characteristic of Candida spp. or Aspergillus spp. were found in necrotic tissue at the bronchial suture of nine patients. The mean duration of the 38 treatments was 3.6+/-2.6 months (range, 0.5-12 months). After a median follow-up of 16 (range, 0-48) months, two cases of extended ulcerative and pseudo membranous Aspergillus fumigatus bronchitis were observed and healed under itraconazole treatment. In conclusion, pre-emptive azole therapy may be effective and well-tolerated in lung transplant patients where fungi are found in the airways or pleura.     

Serologic IgE immune responses against Aspergillus fumigatus and Candida albicans in patients with cystic fibrosis

OBJECTIVES: The objectives of this study were to determine the prevalence of Aspergillus fumigatus and Candida albicans in the sputa of patients with cystic fibrosis (CF), to assess serologic IgE responses of these patients to the presence of fungi in the sputum, to evaluate what effect this may have on clinical status, and to determine how the above-mentioned factors relate to allergic bronchopulmonary aspergillosis (ABPA). PATIENTS: Seventy-six CF patients (40 male and 36 female patients; age, 15.3 plus minus 8.7 years [mean plus minus SD]) were studied. Measurements and results: A total of 1,239 sputum samples from 66 patients were cultured for fungi. A fumigatus was grown in 256 sputum specimens (20.7%), and C albicans was grown in 588 sputum samples (47.5%). Forty patients (60.6%) had at least one positive culture finding for A fumigatus, and 58 patients (87.9%) had at least one positive culture finding for C albicans. Forty-nine patients (64.5%) were sensitized to A fumigatus, and 20 patients (26.7%) were sensitized to C albicans. No correlation was found between the finding of A fumigatus in sputum and IgE to A fumigatus. Only patients who had at least one positive culture finding for C albicans had IgE to C albicans develop. Lung function values and chest radiograph scores were not significantly lower in patients sensitized to either A fumigatus or C albicans as compared to nonsensitized patients. Of the 20 patients sensitized to C albicans, 10 patients had confirmed ABPA and 10 patients had some immunologic characteristics of ABPA. CONCLUSIONS: A high prevalence of colonization and sensitization to A fumigatus and C albicans in CF patients was observed. The sensitization to these fungi was not related to the clinical severity. IgE to C albicans may be an immunologic marker related to the development of ABPA in patients with CF.     

真菌生物被膜的研究进展

真菌生物被膜对患者病死率的影响已经逐渐引起临床医师的重视.产生生物被膜的真菌中,白色念珠菌最为人们熟知,同时,非念珠菌属,如酵母菌类的新型隐孢子菌以及霉菌类的烟曲霉菌也可以引起生物被膜相关感染.真菌生物被膜独特的生长过程,包括黏附、定植、增殖和播散,都有复杂的分子作用机制.强有力的抗真菌治疗仍然是对付真菌生物被膜的最有...     

真菌生物被膜的研究进展

真菌生物被膜对患者病死率的影响已经逐渐引起临床医师的重视。产生生物被膜的真菌中，白色念珠菌最为人们熟知，同时，非念珠菌属，如酵母菌类的新型隐孢子菌以及霉菌类的烟曲霉菌也可以引起生物被膜相关感染。真菌生物被膜独特的生长过程，包括黏附、定植、增殖和播散，都有复杂的分子作用机制。强有力的抗真菌治疗仍然是对付真菌生物被膜的最有效的办法。     

老年患者呼吸系统真菌感染的检测及临床研究

目的 探讨老年患者肺部真菌感染的危险因素和流行病学特征，为控制真菌感染提供依据。方法 根据真菌形态学及生化学特征，进行真菌的鉴定；调查医院真菌感染的流行病学特征；对67例医院真菌感染进行回顾性统计分析。结果 从72份疑似真菌感染患者的痰液标本中，分离得到真菌67株，检出率为93．1％。其中，白色念珠菌感染率最高（53．73％），其次为光滑念珠菌（14．94％）、热带念珠菌（7．46％）、克柔念珠菌（7．46％），构成比与以往报道有差异；除念珠菌属外，还分离到曲霉属（13．43％）等真菌。结论 老年患者肺部真菌感染发生率较高，正确地进行菌种的鉴定，对临床真菌感染的诊断及治疗具有重要意义。     

A rapid colorimetric assay of fungal viability with the tetrazolium salt MTT

A rapid colorimetric assay for viability of fungi that uses the tetrazolium salt MTT is described. All live species of a wide range of medically important fungi that were tested reduced MTT, with resultant intracellular formation within several hours of clearly visible purple crystals of MTT-formazan. The assay proved particularly useful in measuring viability of individual hyphae; greater than 99% of live Aspergillus fumigatus and Rhizopus oryzae hyphae stained purple when incubated with MTT compared with 0% of hyphae killed by any of a variety of methods. The MTT method for measuring fungal viability closely correlated with a slide-culture technique when killing of A. fumigatus hyphae by graded concentrations of hydrogen peroxide was compared. MTT-formazan was easily extracted from the fungi by alcohol, a procedure allowing spectrophotometric quantification of fungal killing in both cell-free and cellular systems. A linear relation between inocula and MTT reduction of several fungi, including Candida albicans blastospores and A. fumigatus hyphae, was demonstrated. Human leukocytes killed 80.3% of C. albicans blastospores as measured by the MTT assay, compared with 70.5% as measured by dilutions and pour plates. Killing of A. fumigatus hyphae by human leukocytes was also quantitated by using the MTT assay.     

Fungal infections in nontransplant patients with hematologic malignancies

Fungal infections are a major cause of morbidity and mortality in patients with hematologic malignancies. Candida and Aspergillus species are the most important opportunistic fungal pathogens in this patient population. Dimorphic fungi can cause serious infection in immunocompetent persons, but infection is more likely to be disseminated in patients with compromised cell-mediated immunity. Cryptococcus neoformans and Pneumosystis carinii typically cause infections in persons with severe T-cell suppression. The frequency of rare pathogenic fungi commonly resistant to amphotericin B has significantly increased over the past 20 years among patients with hematologic malignancies. Examples of such emerging pathogens include Trichosporon, Fusarium, and Scedosporium species, and dark-walled molds. This article reviews the epidemiology, clinical manifestations, diagnostic evaluation, and treatment of the major fungal pathogens in nontransplant patients with hematologic malignancies.     

An epidemiological study for fungus isolation during the twenty-five year periods from 1976 to 2000 in Kitasato University Hospital]

We investigated an epidemiological study for fungus isolation in our hospital from 1976 to 2000. For 25 years, the total sample number of fungus examination were 64,296, and after 1988, the total sample number increased suddenly. As a whole, the positive ratio was constantly about 40%. When our hospital opened, the obstetrical and gynecological samples showed 38.8% for fungus examination, but recently, samples of the respiratory organ has increased. Ratio of isolation for yeast, Candida albicans was 53.8%, and another yeasts such as Candida glabrata, Candida tropicalis, Candida parapsilosis were 12.5%, 5.3%, and 3.4%, respectively. Recently, isolation of Candida glabrata showed a tendency to increase. For genus Aspergillus, Aspergillus fumigatus was isolated, 48.1%, and Aspergillus nigar, Aspergillus terreus were isolated, 31.4% and 7.5%, respectively. For dermatophytes, Trichophyton rubrum was isolated, 63.6% indermatophytes, and another dermatophytes were Microsporum canis (17.9%), and Trichophyton mentagrophytes (15.9%), respectively. For dermatophytes, isolation of Microsporum canis showed a tendency to increase. Recently, the plural number of species showed a tendency to increase in the samples. Compared with the number of samples at the beginning in our hospital, the plural number of species in the samples increased about six times.     

慢性阻塞性肺疾病急性加重期住院患者病原菌分布及耐药分析

目的分析我院呼吸内科慢阻肺急性加重期住院患者痰细菌培养、病原菌分布及耐药情况,为临床医师经验性合理应用抗菌药物提供参考依据。方法回顾性分析我院2013年9月-2015年9月呼吸内科住院1046例AECOPD患者痰细菌培养、药敏及耐药情况。结果 1046例AECOPD患者痰培养分离出病原菌224株,阳性率21.41%。其中,革兰氏阴性菌188株,占83.93%,常见病原菌依次为:肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌;革兰氏阳性菌3株,占病原菌总分布1.35%,分别为:金黄色葡萄球菌、肺炎链球菌、草绿色链球菌;真菌33株,占14.72%,依次为:白色念珠菌、酵母样真菌、曲霉菌、丝状真菌。结论 AECOPD患者病原菌以革兰氏阴性菌为主;临床上对反复感染及病情严重的住院患者应选用广谱β-内酰胺类、氨基糖苷类、喹诺酮类敏感抗菌药物或联合用药;并高度警惕真菌感染。