811例酵母样真菌感染的临床分布及药敏分析

目的分析临床酵母样真菌感染的分布情况,结合真菌的鉴定及药敏,指导临床合理用药。方法回顾性分析真菌感染者的临床资料、检出的酵母样真菌的分布及对抗真菌药物的耐药特点。结果真菌感染以60岁以上老年人居多,占69.4%,感染部位主要为呼吸道、泌尿道及肠道;基本都有抗生素使用史,多有创伤性介入治疗。检出真菌主要为白色假丝酵母菌,共526例,另有热带假丝酵母菌117例,光滑假丝酵母菌86例,近平滑假丝酵母菌57例,其他酵母菌25例。10种抗真菌药物中,耐药性较高的为特比奈芬、制霉菌素和两性霉素B,比较敏感的为5-氟胞嘧啶和酮康唑。两性霉素B33.9%和氟康唑22.6%的耐药率,大大高于以往熟知的程度,这与临床大量常规使用其预防真菌感染有密切联系。结论应加强真菌检测,指导临床合理使用抗生素,减少多重耐药出现。     

科玛嘉念珠菌显色培养基在诊断侵袭性真菌感染中的应用

目的探讨CHROMagar显色培养基检测侵袭性真菌感染的应用价值。方法将2007年7月至2008年6月湖南省肿瘤医院肿瘤病人的呼吸道标本采用CHROMagar显色培养基及沙保罗培养基进行真菌检测,CHROMagar显色培养基上生长的真菌根据菌落的颜色及形态进行鉴别,在沙保罗培养基上生长的真菌经VITEK2-Compact全自动细菌鉴定仪进行鉴定。结果660份标本在沙保罗培养基上分离出383株真菌,经鉴定其中白色假丝酵母菌为262株、热带假丝酵母菌为51株、克柔假丝酵母菌15株、光滑假丝酵母菌34株,其他真菌21株。CHROMagar显色培养基上检出360株真菌,检出率与前者的符合率为93．99％。结论科玛嘉显色培养基能作为临床快速鉴定酵母样真菌感染的方法,对侵袭性真菌感染的早期诊断有意义;但鉴定菌种有限,有一定的局限性。     

新生儿重症监护病房真菌血症病原学及临床分析

目的探讨自2004年1月至2008年12月我院新生儿重症监护病房获得性真菌血症病原学及临床特征,为真菌血症防治提供依据。方法回顾分析5年中新生儿重症监护室发生的33例真菌血症的病原学和临床资料。结果33例真菌血症均为医院获得感染的假丝酵母菌,其中白色假丝酵母菌17株、热带假丝酵母菌10株、近平滑假丝酵母菌5株、光滑假丝酵母菌1株。结论假丝酵母菌属是新生儿重症监护病房真菌血症的主要致病菌,以白色假丝酵母菌最常见,但非白色假丝酵母菌也占较大比例;真菌血症与早产、极低体重儿、机械通气、静脉导管、全胃肠外营养等因素有关。5-氟脲嘧啶、伊曲康唑、两性霉素B和氟康唑对假丝酵母菌耐药性较低,氟康唑是治疗假丝酵母菌属的有效药物。     

泌尿系统感染病原菌分布及药敏分析

目的分析医院泌尿系统感染常见病原菌的分布及其药敏情况,为临床诊断及合理用药提供可靠依据。方法对2008年1月至2009年9月我院尿培养分离出的239株病原菌的分布及药敏分析结果进行回顾性分析。结果泌尿系感染病原菌中革兰阴性杆菌占57.7%,真菌占22.2%,革兰阳性球菌占20.1%;居前3位的是大肠埃希菌（33.1%）、白色假丝酵母菌（10.5%）、粪肠球菌（9.3%）。除鲍曼不动杆菌外,革兰阴性杆菌对碳青酶烯类均具有极高的敏感性。革兰阳性球菌对万古霉素、利奈唑烷和替考拉宁的敏感度均为100%。产超广谱β内酰胺酶（ESBLs）菌及耐甲氧西林金黄色葡萄球菌（MRSA）检出率高。结论本院泌尿系统感染病原菌以革兰阴性杆菌为主,对常见抗生素耐药性较高;真菌感染率高于革兰阳性球菌。了解病原菌分布特点及其药敏情况对临床合理选用抗生素具有重要意义。     

儿童真菌感染的病原学研究

目的探讨广州地区儿童真菌感染的病原分布特点及其耐药状况,为防治儿童真菌感染提供实验室依据。方法对患儿感染部位的真菌进行分离培养和鉴定：以ATB^TM FUNGUS3酵母样真菌药敏试验条进行常用抗真菌药物的敏感性分析。结果从患儿标本中分离出558株真菌,主要来自呼吸道有299株,占53．58％;其次是消化道、伤口（创口）、泌尿系统和血液等,分别占28．14％、6．27％、4．66％、3．76％。其中白色假丝酵母菌367株,占65．77％;其次为热带假丝酵母菌、光滑假丝酵母菌、近平滑假丝酵母菌、克柔假丝酵母菌、季也蒙假丝酵母菌等,分别占15．28％、5．02％、4．48％、3．41％、2．69％。从骨髓中检出5株马尔尼菲青霉,从脑脊液中检出3株新型隐球菌。真菌对两性霉素B、5-氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑等总耐药率分别为8．78％、4．84％、10．54％、1．36％、0．85％。结论引起儿童真菌感染的主要病原菌是白色假丝酵母菌。对真菌感染应该有针对性地使用高效的抗真菌药物进行早期治疗。     

临床常见真菌的分布和药物敏感性分析

目的:了解真菌感染的临床分布、真菌种类及耐药情况,为临床诊治提供依据。方法:采用沙保弱平板或CHROMa-gar平板进行菌株分离、API Candida、API20CAUX菌株鉴定,用Rosco纸片扩散法测定药敏。结果:690份标本,分离出700株真菌,其中假丝酵母菌属占53.5%,白假丝酵母菌占25.6%;痰标本占24.3%;住院患者中以ICU和肾内科分离率高且以白假丝酵母菌为主,分别占59.3%和45.2%;门诊患者以皮肤科分离率高,以近平滑假丝酵母菌为主,占23.4%;酵母样真菌对伊曲康唑、氟康唑、两性霉素B、制霉菌素、酮康唑的敏感率分别为89.4%、83.9%、98.2%、95.9%、96.0%。结论:假丝酵母菌是真菌培养中分离率最高的真菌,分离的主要真菌种类因科室和患者而异。真菌的分离、鉴定和药敏试验对临床使用抗真菌药物具有指导意义,特别是对氟康唑天然耐药菌株的鉴定,有利于抗真菌药物选择。     

AECOPD继发肺侵袭性真菌感染临床特征及预后

目的探索慢性阻塞性肺病急性加重（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）继发侵袭性肺真菌感染的早期诊断方法,以及影响预后的因素。方法查阅2000—2008年因AECOPD入院继发肺真菌感染病例,符合侵袭性肺部真菌感染的诊断标准与治疗原则（草案）者,调阅CT及X档案,记录住院期间抗生素和皮质激素使用史、真菌培养和药敏试验、基础病等进行分析。结果AECOPD合并肺侵袭性真菌感染25例,死亡4例。其病原学分析显示：白假丝酵母菌16例（64％）,光滑假丝酵母菌4例（16％）,热带假丝酵母菌2例（8％）,克柔假丝酵母菌1例（4％）,曲霉菌2例（8％）。胸部CT改变以结节影、结节晕轮征、团块影以及空洞为主,分别为：20、17、14和8例次,其中结节晕轮征具有特征性;X线胸片以支气管肺炎样改变、团块影、空洞和支气管炎改变为主,分别为16、14、5、5例次。预后分析提示：机械通气、抗生素使用时间超过7d、同时使用抗生素种类超过3种、大剂量激素和合并呼吸衰竭等基础病是AECOPD继发肺侵袭性真菌感染预后不良的因素。结论AECOPD继发肺真菌感染预后差,病死率高（16％）,早期胸部CT以及痰检对及早发现肺侵袭性真菌感染有价值。合理使用抗生素,严格掌握AECOPD使用皮质激素以及机械通气的适应证,对改善预后有积极作用。     

下呼吸道感染病原菌构成及耐药性分析

目的了解下呼吸道感染病原菌的分布特点及耐药情况,以更好地为临床合理使用抗菌药物提供科学依据。方法对2009年从临床住院患者分离出来的下呼吸道感染病原菌的分布情况及其耐药性进行回顾性调查和分析。结果 2253株阳性菌株中,G-杆菌有1598株,占70.93%,以铜绿假单胞菌（21.88%）、鲍曼不动杆菌（12.16%）、肺炎克雷伯菌（9.19%）为主;G＋球菌有448株,占19.88%,以金黄色葡萄球菌（18.06%）为主;真菌有207株,占9.19%,以白色假丝酵母菌为主（7.81%）。几种主要病原菌对各类抗菌药物的耐药程度各不相同,但大部分菌株均呈现多重耐药的现象。结论应加强细菌的耐药性监测,做好多重耐药菌患者的隔离治疗,加强抗菌药物应用的管理和督查,以减少多重耐药菌的产生和传播。     

老年晚期肺癌患者真菌性肺炎致病菌及临床特征

目的 总结老年晚期肺癌患者真菌性肺炎的致病菌及临床特征,为临床诊断及治疗提供参考。方法 纳入2017年1月至2020年12月于北京世纪坛医院住院的92例继发真菌性肺炎的老年晚期肺癌患者,收集临床资料和实验室检查结果进行分析。结果 纳入患者的痰标本分离假丝酵母菌属居多,其中白色假丝酵母菌71株,占比最多,达77.2%,对氟康唑的耐药率为8.5%,对伏立康唑耐药率为1.4%。不同致病菌在腺癌和鳞癌患者中分布差异无统计学意义。胸部X线或CT表现以斑片状阴影最多见,占81.5%。合并高血压、冠心病、糖尿病患者较多,分别占40.0%,31.6%和19.7%。所有患者均有不同程度的发热,并伴有咳嗽、咳痰症状。经抗真菌药物治疗后,治愈率为79.3%,病死率20.7%,多数患者死于呼吸衰竭。结论 老年晚期肺癌患者真菌性肺炎的致病菌多为白色假丝酵母菌,耐药率低,胸部影像不典型,多数表现为斑片状阴影。患者合并症多,多数死于呼吸衰竭,临床应综合分析病情,合理用药。     

焦作市第二医院感染白假丝酵母菌患者的耐药变迁

近年来肿瘤患者及自身免疫性疾病患者的增多,以及临床广谱抗菌药物的不规范使用使真菌感染逐年增多.真菌对临床抗真菌药物耐药性使真菌感染的治疗困难越来越大,其中以白假丝酵母菌最为常见.     

下呼吸道感染病原菌分布及耐药性分析

目的 了解医院呼吸科下呼吸道感染的病原菌分布及耐药性情况。方法 收集呼吸科下呼吸道感染住院患者的痰标本,进行统计分析。结果 检测出革兰阴性菌占78.25%,前四位为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌;真菌占13.49%,以白色念珠菌为主。革兰阳性菌占8.26%,以金黄色葡萄球菌为主;药敏试验显示,革兰阴性菌中,妥布霉素耐药率最低,其次是阿米卡星。结论 呼吸科细菌耐药现象严重,加强病原菌耐药性监测,合理使用抗菌药物。     

Immune escape of the human facultative pathogenic yeast Candida albicans: the many faces of the Candida Pra1 protein

Infectious diseases caused by human pathogenic fungi represent a major and global health problem. Based on the limited efficacy of existing drugs and the increasing resistance to antifungal compounds, new strategies are urgently needed to fight such fungal infections. The medically important pathogen Candida albicans can exist as an opportunistic yeast, but can also cause severe diseases, septicaemia, and death. In order to establish new strategies to fight Candida infections and to interfere with survival of the pathogen, it is highly relevant to understand the molecular and immunology interactions between the pathogen C. albicans and the human host. This immune cross talk has moved into the focus of infectious disease research. In this review, we summarize the diverse and multiple levels of the immune cross talk between the fungal pathogen C. albicans and the human host. In particular, we define how one single fungal protein Pra1 (pH-regulated antigen 1) interferes and controls host immune attack at multiple levels and thus contributes to fungal immune escape. Candida Pra1 represents a promising candidate for immune interference.     

A review of Candida species causing blood stream infection

The incidence of candidemia has been on a rise worldwide. The epidemiology of invasive fungal infections in general and of candidemia in particular has changed in the past three decades because of a variety of factors like the AIDS epidemic, increased number of patients receiving immunosuppressive therapy for transplantation and the increasing use of antimicrobials in the hospital setups and even in the community. The important risk factors for candidemia include use of broad-spectrum antimicrobials, cancer chemotherapy, mucosal colonization by Candida species, indwelling vascular catheters like central venous catheters, etc. More than 90% of the invasive infections due to Candida species are attributed to five species-Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis and Candida krusei. However, the list of new species of Candida isolated from clinical specimens continues to grow every year. Early diagnosis and proper treatment is the key for management of candidemia cases.     

In vitro and in vivo antifungal activities of FX0685, a novel triazole antifungal agent with potent activity against fluconazole-resistant Candida albicans.

To evaluate the therapeutic potential of FX0685, a new triazole antifungal agent, for the treatment of opportunistic fungal infections, particularly systemic candidiasis and aspergillosis, in vitro and in vivo studies were performed using fluconazole (FLC), itraconazole (ITC) and/or amphotericin B (AMB) as reference drugs. A preliminary in vitro study showed that the antifungal activity of FX0685 against FLC-susceptible Candida albicans, several non-C. albicans Candida species and Cryptococcus neoformans was superior to that of FLC and comparable or superior to those of ITC and AMB, while the anti-Aspergillus fumigatus activity of FX0685 was to varying degrees lower than that of ITC. FX0685 appeared to be comparable to FLC and ITC in the treatment of murine systemic C. albicans and pulmonary A. fumigatus infection, respectively. The biological property of FX0685 was characterized by its potent in vitro and in vivo activity against FLC-resistant C. albicans. Part of this unique property was explained by the finding that it retained potent inhibitory activity against those CYP51 molecules in which amino acid substitutions confer a phenotype of resistance to FLC and some other azole derivatives. All of these results lead to the possibility that FX0685 may be a potential antifungal drug candidate for the treatment of various clinical forms of systemic candidiasis, including those caused by FLC-resistant C. albicans, as well as for the treatment of pulmonary aspergillosis.     

Simple and rapid detection of Candida albicans DNA in serum by PCR for diagnosis of invasive candidiasis

A rapid and sensitive PCR assay for the detection of Candida albicans DNA in serum was established. DNA from human serum samples was purified using the QIAamp blood kit, which proved to be a fast and simple method for isolating minute amounts of Candida DNA from clinical specimens for diagnosis of invasive candidiasis. Universal primer sequences used in the PCR assay are derived from the internal transcribed spacer rRNA gene of fungi, whereas the biotinylated hybridization probe used in a DNA enzyme immunoassay (DEIA) binds specifically to C. albicans DNA. The sensitivity of this PCR-DEIA method is very high; the detection limit for genomic Candida DNA is one C. albicans genome per assay. Blood from uninfected and infected persons, ranging from healthy volunteers, patients with mucocutaneous infections, and patients at risk to develop a systemic Candida infection to patients with an established systemic candidiasis, was analyzed for the presence of C. albicans to diagnose fungal infection. Candida DNA could not be detected in sera of 16 culture-negative controls and from 11 nonsystemic candidal infections by PCR or DEIA. Blood cultures from patients at risk were all negative for Candida, whereas all blood cultures from systemic candidiasis patients were positive. However, Candida DNA could be detected by PCR and DEIA in the serum from three out of nine patients who were at risk for a systemic infection and in the serum of all seven patients who had already developed an invasive Candida infection. PCR is more sensitive than blood culture, since some of the patients at risk for invasive yeast infection, whose blood cultures were all negative for Candida, tested positive in the PCR amplification. These results indicate the potential value of PCR for detecting C. albicans in serum samples and for identifying patients at risk for invasive candidiasis.     

Candida dubliniensis: a novel emerging species

Over the past decade, the incidence of opportunistic fungal infections continues to increase. Candida albicans remains the most important pathogenic yeast. Since 1995, a novel Candida specie has been identified and named Candida dubliniensis. This specie shares many phenotypic characteristics with Candida albicans, including the ability to produce germ tubes and chlamydospores. These similarities have caused significant problems in the identification of Candida dubliniensis. A large variety of methods have been developed for the discrimination of these two species. They included the sensitivity to different stress (temperature, salinity), growth on chromogenic and specific medium and carbohydrate assimilation. However, these methods can fail to assert the identification of Candida dubliniensis, but molecular typing methods are highly reliable and can confirm the identification. However, they are too complex for routine use. The identification of this specie in routine is essential in order to further understand the epidemiology, to better define the role of Candida dubliniensis as a potential pathogen and its susceptibility to develop a resistance to the antifungal agents. So, new methods have to be developed.     

816株真菌感染分布及药敏分析

目的了解本院医院感染真菌分布的特点及对常用抗真菌药物的耐药情况。方法CHROMagar显色培养基及ATB真菌试剂盒进行鉴定;药敏试验采用纸片扩散K—B法。结果2008年1月至2009年6月我院临床共分离真菌816株,其中白色念珠菌（占53．2％）是引起真菌感染的最常见菌种,其次是热带念珠菌（21．6％）、光滑念珠菌（15．6％）、近平滑念珠菌（5．0％）和克柔念珠菌（2．3％）。药敏试验结果显示各种真菌对两性霉素B、制霉菌素的敏感性最高,分别达98％和99％,其次是氟康唑、伊曲康唑。结论真菌感染率呈逐年上升趋势,耐药率也逐渐增高。因此应及时对送检标本进行真菌培养和药敏试验,合理使用抗真菌药物,减少医院感染多重耐药和深部真菌感染的发生。