肿瘤化疗患者假丝酵母菌感染的研究

目的：研究住院肿瘤化疗患者中假丝酵母菌感染的分布及耐药性,为临床合理应用抗真菌药物提供依据。方法：用法国生物梅里埃公司提供的ID 32C做假丝酵母菌的鉴定,按CLSI要求,用ATBTM Fungus真菌药敏试验板条进行药敏试验。结果：假丝酵母菌属感染的主要真菌有5种,其中以白色假丝酵母菌最多,占55.3%;其他依次为热带假丝酵母菌占13.0%,光滑假丝酵母菌占12.6%,近平滑假丝酵母菌占8.9%,克柔假丝酵母菌占4.8%;假丝酵母菌耐药吡咯类较普遍,5-氟胞嘧啶次之（17.3%）,对两性毒素B耐药（2.5%）的较少。结论：假丝酵母菌属感染主要由白色假丝酵母菌引起;假丝酵母菌对目前抗真菌药呈普遍耐药性,应联合足量用药。     

消化系统肿瘤患者术后真菌感染病原菌分布及耐药性分析

目的 分析消化系统肿瘤患者术后真菌感染病原菌分布特点及耐药情况,从而为临床预防和诊治提供依据.方法 随机选取消化系统肿瘤术后患者1000例为调查对象,其中合并真菌感染患者91例,感染率为9.1％.收集标本,对检出的病原菌进行菌属鉴定,同时进行药敏试验.结果 年龄、远处转移以及肿瘤分期是影响肿瘤患者术后真菌感染的因素(P＜0.05).91例感染患者中,呼吸系统感染72例,占79.12％,消化系统感染17例,占18.68％,泌尿系统感染3例,占3.30％;91株真菌中,白色假丝酵母-菌59株,占64.84％,热带假丝酵母菌12株,占13.19％,光滑假丝酵母菌11株,占12.09％,克柔假丝酵母菌7株,占7.69％,其他2株,占2.20％;91例患者中,合并细菌二重感染58例,占63.74％.以革兰阴性菌为主,占94.83％,其中包括肺炎克雷伯菌、鲍氏不动杆菌、大肠埃希菌、铜绿假单胞菌等.合并革兰阳性菌占5.17％,为葡萄球菌属;白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌以及克柔假丝酵母菌对两性霉素、伏立康唑耐药性为0,对氟康唑和氟康唑有较低耐药率.结论 消化系统肿瘤术后患者真菌感染以白色假丝酵母菌为主,且多合并细菌感染,以革兰阴性菌为主,好发部位为呼吸道,临床上应根据药敏试验结果采取有效的药物治疗.     

癌症患者痰培养常见菌谱及其耐药性分析

背景与目的:有些癌症患者并非死于癌症本身,而是死于手术、化疗、放疗、介入治疗后合并感染.本研究主要探讨癌症患者痰培养所得病原菌的分布及其耐药状况.方法:回顾性分析955例癌症患者医院感染痰培养感染病原菌的临床资料,采用WHONET-5软件对相关资料进行统计学处理.结果:感染菌检出率:真菌为43.4%,以白色假丝酵母菌为主;革兰氏阳性(G )球菌为31.2%,以凝固酶阴性葡萄球菌为主;革兰氏阴性(G-)杆菌为25.4%,以铜绿假单胞菌和肺炎克雷伯菌为主.药敏试验结果提示:真菌对两性霉素B敏感,对唑类抗菌药物呈耐药性.G 球菌对万古霉素高度敏感,对苯唑西林、青霉素、红霉素等耐药率很高.G-杆菌对亚胺培南高度敏感,对一代、二代头孢菌素、氨苄西林、哌拉西林等有较高的耐药性.结论:癌症患者院内感染痰培养显示,常见菌谱为真菌、G 球菌和G-杆菌,临床用药应依据药敏试验结果合理使用抗生素.     

血液肿瘤并发真菌血症23例

 目的　对恶性血液肿瘤并发真菌血症的临床及微生物学特征进行分析,为临床诊治提供参考。方法　对23例恶性血液肿瘤并发真菌血症的临床资料、危险因素、真菌菌群分类以及治疗及预后进行回顾性分析。结果　真菌血症患者病情危重,大多有2种或2种以上的危险因素;菌种分布显示白假丝酵母菌占47 ％;近平滑假丝酵母菌占17 ％;光滑假丝酵母菌占12 ％。23例患者中,13例治愈（56.5％）、8例死亡（34.7 %）;2例放弃（8.6 %）。结论　对有高危因素的恶性血液肿瘤患者应重视真菌血症的发生,积极治疗原发病,加强病原学检测和药敏试验,及时早期诊断并合理选用抗真菌药物可改善预后。     

肿瘤患者医院真菌感染及耐药性监测

目的:了解肿瘤患者医院真菌感染及耐药状况,为合理选用抗真菌药提供依据.方法:对我院送检的863例患者标本培养及药敏试验结果进行分析.结果:863例患者共检出真菌121株(占14.02%).其中以白色念珠菌最为常见,占69.4%(84/121).药敏结果显示:本组真菌对益康唑(ECO)、酮康唑(KET)的耐药率较高,分别为34.7%和29.0%,而对咪康唑(MIC)、两性霉素B(AMB)、制霉菌素(NYS)和5-氟胞嘧啶(5-FC)的耐药率分别为20.0%、3.3%、1.65%和1.65%.结论:肿瘤患者并发真菌感染以白色念珠菌为主.应根据药敏结果合理用药.     

肿瘤患者念珠菌血症的危险因素和病原体分析

  目的  本研究旨在确定念珠菌血症的危险因素, 评估肿瘤患者中近平滑假丝酵母菌和其他念珠菌之间可能存在的临床显著性差异。并对白假丝酵母菌血症和近平滑假丝酵母菌血症的临床特点及危险因素进行统计学分析, 旨在通过该类分析, 及时开展干预, 尽量避免易感因素, 进而改善真菌血症患者预后。  方法  回顾性分析郑州大学附属肿瘤医院2012年3月至2018年2月323例念珠菌血症患者的资料。分析患者发生念珠菌血症的危险因素, 同时对比分析近平滑假丝酵母菌和非近平滑假丝酵母菌、白假丝酵母菌和非白假丝酵母菌念珠菌血症的临床差异。通过微量肉汤稀释法对念珠菌常见抗真菌药物进行药敏试验和分析。  结果  念珠菌血症分离病原体中, 最常见的为近平滑假丝酵母菌37.15%（120/323）, 而白假丝酵母菌占34.37%。多变量回归分析结果表明, 下述因素与近平滑假丝酵母菌念珠菌血症的发生相关, 即肠外营养（P < 0.001）、粒缺（P < 0.001）、化疗（P < 0.001）和抗真菌药物的使用（P < 0.001）, 同时肠外营养为近平滑假丝酵母菌念珠菌血症发生的独立危险因素（OR=0.183, 95%CI:0.098~ 0.340;P < 0.001）。  结论  近平滑假丝酵母菌超越白假丝酵母菌为患者念珠菌血症主要病原体。通过评估患者念珠菌血症发生的可能危险因素, 以期加强和制定感染控制策略, 从而预防念珠菌血症的传播。      

肿瘤患者感染病原菌的分布及耐药性分析

目的:了解肿瘤患者感染病原菌的分布及耐药性分析,为合理用药提供依据。方法:对本院肿瘤患者送检的合格标本分离菌株进行培养鉴定和耐药性分析。结果:405株病原菌中G-杆菌228株,占56.3%;G+球菌67株,占16.5%;真菌110株,占27.2%;药敏试验结果提示G-杆菌对亚胺培南、美罗培南高度敏感,对氨苄西林、哌拉西林耐药率很高。结论:肿瘤患者易发生院内感染且易产生耐药株,在选择抗生素时应依据药敏实验结果合理选用药物,控制病原菌的耐药性。     

肺癌患者化疗期间肺部真菌感染病原菌分布及使用伊曲康唑的疗效观察

目的探讨肺癌患者化疗期间肺部真菌感染病原菌分布及使用伊曲康唑的治疗效果。方法选取2016年8月至2018年12月间延安市人民医院收治的397例肺癌患者的临床资料进行回顾性分析,临床资料包括患者感染发生情况、感染病原菌及其耐药性、治疗前后中性粒细胞、炎症因子水平和肺功能等资料,并进行统计学分析。结果肺癌患者化疗期间肺部真菌感染病原菌以烟曲霉菌、新生隐球菌以及白色假丝酵母菌的感染概率最高,在感染患者中的占比分别是26. 2%、23. 8%和23. 8%。热带假丝酵母菌、光滑假丝酵母菌及毛霉菌的感染概率均较小。两性霉素B的耐药率总体高于伊曲康唑,尤其是主要感染菌烟曲霉菌、新生隐球菌以及白色假丝酵母菌对两性霉素的耐药率分别为18. 2%、10. 0%和30. 0%,均高于对伊曲康唑的耐药率,差异均有统计学意义(均P <0. 05)。患者治疗后中性粒细胞计数明显少于治疗前,而超敏C反应蛋白(hs-CRP)、降钙素原(PCT)以及白介素-6(IL-6)水平在治疗后明显比治疗前高,差异均有统计学意义(均P <0. 05)。患者治疗后最大呼气第一秒呼出气体量容积(FEV1)、用力呼气量(FVC)和FEV1/FVC各指标水平均较治疗前有大幅度提升,差异均有统计学意义(均P <0. 05)。结论肺癌患者化疗后真菌感染率较高,尤其是烟曲霉菌、新生隐球菌以及白色假丝酵母菌,且患者采用伊曲康唑治疗效果较好,可以推广应用。     

2006—2007年中山大学附属肿瘤医院患者医院感染病原菌分布特点及耐药性分析

背景与目的：肿瘤患者免疫力低下,容易发生感染,不仅给肿瘤的治疗带来困难,也是肿瘤患者死亡的重要原因。本研究主要对发生医院感染的肿瘤住院患者的易感因素、病原菌分布及耐药情况进行分析。方法：回顾性调查中山大学附属肿瘤医院2006—2007年发生医院感染的952例住院患者的临床资料,采用EXCEL8．0和SPSS10．0对医院感染一般情况、病原菌分布及耐药情况进行统计和分析。结果：952例发生医院感染的患者中,分离出了病原菌794例,检出率为83．4％。其中检出革兰阴性杆菌321例,占所有病原菌的40．4％,主要是大肠埃希菌感染;真菌265例,占33．4％,以白色假丝酵母菌感染为主;革兰阳性球菌208例,占26．2％,主要是葡萄球菌属和链球菌属感染。药敏结果提示革兰阴性杆菌主要对亚胺培南、丁胺卡那敏感,而对氨苄西林的耐药率则在90％以上：革兰阳性球菌对万古霉素高度敏感。此次调查中没有发现对万古霉素耐药细菌,而对氨苄西林耐药严重：真菌对两性霉素B、伏立康唑及氟胞嘧啶敏感,而对氟康唑的敏感性稍差。结论：中山大学附属肿瘤医院2006—2007年住院患者医院感染病原菌主要为革兰阴性杆菌,临床用药应根据药敏结果合理使用抗生素,减少真菌感染和细菌耐药,从而有效预防和控制感染。     

肿瘤患者白色假丝酵母菌感染的变化

临床标本中白色假丝酵母菌最多见 ,一般认为白色假丝酵母菌是酵母菌中最常见、最主要的人体机会致病菌 [1 ] 。随着临床抗生素、免疫抑制剂和激素的广泛应用 ,机会致病菌的院内感染包括真菌感染有增加趋势。尤其是肿瘤患者 ,自身免疫功能低下 ,白色假丝酵母菌感染更是逐年增加。我院 1992年 7月—2 0 0 2年 7月共收到住院患者痰标本 35 0 7份 ,分离出白色假丝酵母菌 5 93株。现通过病例调查分析白色假丝酵母菌感染的变化情况。1　材料与方法1.1　实验材料1.1.1　菌株来源 :5 93株白色假丝酵母菌均来自我院住院患者痰标本。1.1.2　质控菌 :A…     

Microbial profile and drug resistance of Candida strains isolated from the blood of children: an 11-year study

The latest observations indicate a continuous increase in the frequency of fungal infections, particularly in hospital patients, accompanied by changes in both the profile of the isolated strains and their drug susceptibility. The objective of this study was to evaluate the trend in the incidence of candidaemia and susceptibility of antifungal drugs in the Polish Mother's Memorial Hospital over an 11-year period. Blood samples taken from the hospitalised children were sent to the Department of Clinical Microbiology for diagnostic purposes. A total of 195 Candida strains were isolated: 47.7% Candida albicans and 52.3% non- albicans . Candida parapsilosis was isolated in 65.7% of non- albicans strains. The prevalence of Candida spp. decreased from 16.9–20.5% in the years 1996–1997 to 3.1–2.1% in the years 2005–2006. In the years 2000–2005, non- albicans strains were more prevalent. All C. albicans strains were susceptible to amphotericin B, 2.94% of non -C. albicans strains were semisusceptible to amphotericin B, 98.92% of C. albicans and 85.29% of non- albicans strains were susceptible to 5-fluorocytosine. Candida spp. strains are predominant pathogens in fungaemia in children in our hospital. Over the last few years, C. albicans have been replaced by non- albicans strains (predominantly C. parapsilosis ), which exhibit a higher level of drug resistance. The number of Candida spp. isolated from blood decreased during the 11-year study.     

Susceptibility of Candida albicans to common and novel antifungal drugs, and relationship between the mating type locus and resistance, in Lebanese hospital isolates

The incidence of antifungal resistance is on the increase worldwide and novel drugs are constantly being developed to counter this trend. One hundred and sixteen clinical isolates of Candida albicans were collected from Lebanese hospitals in order to first determine the degree of resistance of Lebanese isolates to four common azoles: fluconazole (FL), itraconazole (IT), ketoconazole (KE), and voriconazole (VO), in addition to amphotericin B (AP) and caspofungin (CS) through the Epsilometer test method and second, determine any relationship between the allelic compositions of the mating type loci ( MTLa , MTL α , MTLa/α ) with drug resistance. Results showed that resistance, among C. albicans isolates, was the highest with 12% for IT, followed by 7.7% for VO, 6% for KE, 5% for FL, 1.7% for AP and 0% for CS. Three isolates (2.6%) were resistant to all azoles tested, including one that was resistant to all drugs used except CS. Eleven isolates were homozygous at the MTL locus (9.5%), five of which (45%) were resistant to at least one antifungal drug whereas 14 of the 105 heterozygous strains (13%) exhibited similar resistance ( P  = 0.02), indicating a strong correlation between MTL locus homozygosity and resistance.     

Oral yeast carriage in HIV-infected and non-infected populations in Rosario, Argentina

The objectives of the present study were: (i) to assess the frequency of oral colonisation by Candida species in HIV-positive patients and to compare it with a population of HIV-negative individuals, (ii) to determine the prevalence of C. dubliniensis in both populations and (iii) to determine the susceptibility of C. dubliniensis and other Candida species isolated from HIV-positive patients to the most commonly used antifungal agents. Oral samples were obtained from 101 HIV-positive and 108 HIV-negative subjects. For yeast identification, we used morphology in cornmeal agar, the API 20C Aux, growth at 45 °C, d -xylose assimilation, morphology in sunflower seed agar and PCR. The frequency of isolation of Candida in HIV-positive patients was: C. albicans , 60.7%; C. dubliniensis , 20.2%; C. glabrata , 5.6%; C. krusei , 5.6%; C. tropicalis , 4.5%; others, <5%. The frequency of isolation of Candida in HIV-negative patients was: C. albicans , 73.9%; C. tropicalis , 15.5%; C. dubliniensis , 2.1%; C. glabrata , 2.1%; C. parapsilosis , 2.1%; others, <5%. The oral colonisation by yeast in the HIV-positive patients was higher than that in the HIV-negative subjects. The susceptibilities of 42 Candida isolates to three antifungal agents were determined. All isolates of C. dubliniensis were susceptible to fluconazole, although several individuals had been previously treated with this drug. Out of the 42 Candida isolates, 10 presented resistance to fluconazole and 10 to itraconazole. The presence of Candida species, resistant to commonly used antifungal agents, represents a potential risk in immunocompromised patients.     

Epidemiological and clinico-mycological profile of fungal wound infection from largest burn centre in Asia

The current study was conducted to know the incidence, predisposing factors, spectrum, clinical profile and antifungal susceptibility (AFS) of fungal wound infection (FWI) in burn patients. Of a total of 71 patients, 20 (28.2%) emerged with the diagnosis of FWI. Fungal pathogens in this study were Candida tropicalis (14%), Candida parapsilosis (5.6%), Aspergillus niger (2.8%) and one each of Candida albicans (1.4%), Candida glabrata (1.4%), Syncephalestrum (1.4%) and Fusarium solani (1.4%). All patients with mould infections expired before the mycological culture results could be conveyed to clinicians. Of the yeasts isolated in the study, one each of C. tropicalis and C. albicans showed cross-resistance to azoles. All the moulds were susceptible to amphotericin B. This study depicted that fungal invasion is associated with a high mortality, burn size 30-60% and high incidence of inhalational injury. Fungal invasion was detected on an average of 14 days after injury. Association of use of four classes of drugs - aminoglycosides, imipenem, vancomycin and third generation cephalosporins and use of total parenteral nutrition was observed. Expedient laboratory diagnosis of FWI and appropriate systemic antifungal therapy guided by AFS may improve outcome for severely injured burn victims.     

Multiple-species candidemia in patients with cancer

BACKGROUND: Candidemia is a common cause of bloodstream infections in patients with cancer, with the majority of these infections being caused by a single Candida species. Studies of multiple-species candidemia (MSC) have rarely been reported. METHODS: The authors identified 33 patients with cancer who had candidemia (diagnosed between 1993 and 2000) caused by more than 1 Candida species. This group of 33 patients was compared with a control group of 66 patients with cancer who had C. albicans candidemia that arose soon before or soon after each case of MSC that was investigated in the current study. RESULTS: Patients with MSC, compared with control patients, were more likely to have leukemia (33% vs. 8%; P = 0.001), to have had prolonged neutropenia before the onset of their infection (mean +/- standard deviation, 10 +/- 17 days vs. 3 +/- 6 days; P = 0.02), and to have received chemotherapy within 1 month before their infection (42% vs. 18%; P = 0.01). Patients with MSC also had higher Acute Physiology and Chronic Health Evaluation II scores at the onset of infection (score > or = 16, 45% vs. 26%; P = 0.05) and were more likely to have received previous antifungal prophylaxis compared with patients who had candidemia caused by C. albicans (33% vs. 11%; P = 0.006). The response of C. albicans candidemia to single-agent antifungal therapy was significantly better than that of MSC (69% vs. 35% P = 0.004). CONCLUSIONS: In patients with cancer, MSC was more likely to occur as breakthrough candidemia, predominantly in those with leukemia and prolonged neutropenia, and was associated with suboptimal responses to single-agent antifungal therapy.     

Identification of Candida species isolated from patients in intensive care unit and in vitro susceptibility to fluconazole for a 3-year period

Species level identification of Candida and antifungal susceptibility testing is not generally performed in routine laboratory practice. There is limited information about the distribution of Candida species and antifungal susceptibility in Turkey. In this study, we aimed at identifying Candida isolates to species level from various samples obtained from patients treated in an intensive care unit between 2002 and 2005 and to evaluate fluconazole susceptibilities of the isolates. A total of 320 Candida isolates obtained from 270 patients were identified by conventional methods and using API (Candida and/or 20C AUX) system. Antifungal susceptibility testing was performed by broth microdilution method. Candida albicans was isolated with the highest frequency (65.6%) followed by C. parapsilosis (11.3%), C. glabrata (8.8%) and C. tropicalis (7.8%). Of all the isolates, 92.9% revealed susceptibility to fluconazole. Susceptibility to fluconazole was highest for C. albicans followed by C. parapsilosis and C. glabrata. The MIC(90) values for C. albicans, C. parapsilosis, C. glabrata and C. tropicalis were 1, 2, 8 and 4 mug ml(-1) respectively. Fluconazole remains effective against both C. albicans and the majority of non-albicans Candida species. In this study, we determine the distribution of Candida species and evaluate the susceptibilities of the isolates, particularly for the azoles.     

Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period

In a retrospective analysis of 128 cases of Candida bloodstream infections in a London teaching hospital between 1995 and 2001, the incidence of candidaemia increased from 0.2/1000 admissions in 1995 to 0.5 and 0.4/1000 admissions in 2000 and 2001, respectively. Risk factors for candidaemia included the presence of intravascular (IV) lines (88%), admission to intensive care (51%), parenteral nutrition (35%), multiple antibiotics (74%), corticosteroid therapy (12%), cancer chemotherapy (11%), renal transplantation (5%) and neutropenia (3%). The sources of infection were IV lines (77%), the urinary tract (7%) and the gastrointestinal tract (7%). Serious infective complications (endocarditis, endophthalmitis or brain abscess) were noted in 6% of cases. The most frequently isolated species were Candida albicans (64%), C. glabrata (20%), C. tropicalis (9%) and C. parapsilosis (5%). The overall fluconazole-resistance rate of Candida spp. was 7% (MIC > or = 64 mg l-1). All the C. albicans isolates were sensitive to fluconazole (MIC < or = 8 mg l-1) whereas 20% of non-C. albicans isolates (27% of C. glabrata and 14%C. tropicalis) were resistant. The mortality rate (35%) was lower than in other reports and may be due to the early recognition of candidaemia and the prompt removal of IV lines together with the initiation of appropriate antifungal therapy. Regular surveillance of local Candida species, resistance profiles and risk factors is important in order to identify patients at risk and to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.