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。     

Regulatory oversight and safety of probiotic use

Depending on intended use of a probiotic (drug vs. dietary supplement), regulatory requirements differ greatly. For dietary supplements, premarketing demonstration of safety and efficacy and approval by the Food and Drug Administration are not required; only premarket notification is required. Saccharomyces boulardii is a probiotic regulated as a dietary supplement intended for use by the general healthy population, not as a drug to prevent, treat, or mitigate disease. However, since recent increases in incidence and severity of Clostridium difficile infection, probiotics have been used to treat recurrent and/or refractory disease in hospitalized patients. Saccharomyces fungemia secondary to use of the probiotic has been described for patients who are critically ill, are receiving nutrition enterally, or have a central venous catheter. Before use of a probiotic is considered for hospitalized patients, careful assessment of risk versus benefit must be made. To ensure patient safety, probiotics should be properly handled during administration.     

真菌血症患者血小板计数动态变化回顾分析

目的调查了解临床真菌血症患者血小板计数动态变化情况,分析其与真菌血流感染发生、发展和转归的关系。方法收集2011年10月至2013年5月白求恩国际和平医院住院患者中发生真菌血症患者的临床资料,分析血小板计数动态变化情况,对数据进行整理和统计分析。结果重症感染(50.00%)和恶性肿瘤(34.38%)是真菌血症患者最主要的基础疾病。32例真菌血症患者中17例(53.13%)发生血小板计数明显下降。血小板计数动态曲线形态呈现3种变化形态:平稳型(15例)、U型(10例)和L型(7例),其病死率分别为20.00%、20.00%和100.00%,3种血小板曲线形态患者预后差异有统计学意义(χ2=14.93,P0.05)。结论在真菌血症患者中,发生血小板下降的概率较大。血小板下降,尤其是经治疗无法回升的患者往往病情凶险,应引起临床高度重视。     

Fatal Trichosporon fungemia in patients with hematologic malignancies

Objective: Invasive Trichosporon infection has been increasingly recognized in patients with hematologic malignancies. Our study aims to clarify the clinical characteristics of this disease and factors influencing patient prognosis. Patients and methods: We retrospectively analyzed 33 cases of Trichosporon fungemia (TF) in patients with hematologic malignancies treated at our collaborating five hospitals in Japan between 1992 and 2007. Results: The majority of these patients had acute leukemia (82%), neutropenia (85%), and a history of intensive chemotherapy (91%). TF occurred as a breakthrough infection during antifungal therapy in 30 patients (91%), 18 of whom were receiving micafungin. The surveillance cultures of most patients were negative for Trichosporon. Only a few patients exhibited elevated levels of 1,3‐β‐d ‐glucan before positive blood culture. Twenty‐five patients (76%) died of this infection. The resolution of infection was associated with neutrophil recovery (P = 0.0001), absence of hyperglycemia (P = 0.023), and azole inclusive therapy (P = 0.031). Survival was significantly longer in patients receiving antifungal therapies containing azole than in those who did not receive azole (P = 0.0034). Conclusions: At present, the diagnosis of invasive trichosporonosis depends on blood culture studies, and the mortality of this disease is high; however, azole therapy and control of blood glucose level, together with hematopoietic recovery could help in improving the clinical outcome. When we use antifungals lacking anti‐Trichosporon activity, sufficient care should be taken to prevent the development of breakthrough trichosporonosis.     

深静脉置管血液透析患者真菌感染的易感因素及护理对策

目的探讨血液透析患者带涤纶环深静脉留置导管真菌感染的易感因素，为临床制订预防感染的护理措施提供理论依据。方法观察24例采用带涤纶环深静脉留置导管行维持性血液透析患者真菌感染发生率、临床表现、治疗转归，并分析易感因素。结果5例（20.83％）发生导管相关性真菌感染，感染真菌均为假丝酵母菌，药物敏感试验提示氟康唑敏感性最高；氟康唑导管内滴注治疗3例有效；导管相关性真菌感染与近期抗生素的应用、导管置入时间有关（均P〈0.05）。结论导管相关性真菌感染不可忽视，了解其临床特点、易感因素，采取针以性预防措施，对减少感染发生率、延长导管的使用寿命具有重要意义。     

Performance of the Candida mannan antigen detection in patients with fungemia

For several years, the Platelia Candida mannan antigen enzyme immunoassay (Candida EIA) has been commercially available as a diagnostic test for invasive candidosis. We evaluated the Candida EIA with patients with proven fungemia caused by yeasts from which at least one serum sample was available. Fifty-nine patients with 121 serum samples were included in the study. Sixty-one different yeast strains were isolated from positive blood-cultures. The Candida EIA was positive (n = 35) or borderline positive (n = 8) in 43 of 59 patients with fungemia, resulting in an overall sensitivity of 73%. For the different yeast species, the following sensitivities were calculated: Candida albicans 30 of 39 (77%), Candida glabrata 7 of 11 (64%), Candida parapsilosis 1 of 3, Candida tropicalis 2 of 2, Candida kefyr 2 of 2, Candida lipolytica 0 of 1, Candida lusitaniae 1 of 1, Candida krusei 1 borderline positive of 1, Saccharomyces cerevisiae 1 of 1. In six patients the antigen levels over time were evaluable. In three cases the antigen was positive 3-4 days before the day the blood culture was drawn, in one case on the same day, and in two cases 2 and 5 days afterwards. In conclusion, the Candida EIA was suitable for the detection of fungemia due to the major facultatively pathogenic yeast species. The test was positive in about half of the patients before blood cultures became positive. In these cases, it contributed to an early diagnosis of invasive candidiasis.     

The yeast species causing fungemia at a university hospital in Riyadh,Saudi Arabia,during a 10-year period

This study is a retrospective investigation to determine the species of yeasts causing fungemia in a university hospital in Saudi Arabia during the years 1991-2000. A total of 189 episodes of fungemia were encountered, of which 121 (64%) occurred during 1991-1995, whereas only 68 cases (36%) were found between 1996 and 2000. Overall, 50.3% episodes were due to Candida albicans including five episodes of C. dubliniensis, followed by C. tropicalis (27%), C. parapsilosis (7.9%), C. glabrata (7.4%), C. krusei (3.2%), C. famata (1.0%); 3.2% were due to other species, namely Blastoschizomyces capitatus, Hansenula anomala, Rhodotorula rubra, and Trichosporon beigelii. The percentage of episodes of fungemia caused by C. albicans ranged from 36.4% in 1991 to 71.4% in 2000, revealing an increase in recent years. The incidence of non-C. albicans fungemia decreased from 63 (33.3%) during the first 5 years (1991-1995) to 31 (16.4%) episodes during the second 5 years. Moreover, no fungemia due to C. glabrata and C. krusei were observed during the last 3 years. Overall, during the years of the study, a decreasing incidence of yeast fungemia was observed. Fungemia occurred more frequently in patients with leukemia (24%), prematurity (16%), postsurgery (10.6%), and lymphoma (9.5%). Patients with respiratory infections and preterm infants more often had C. albicans fungemia, whereas C. tropicalis predominated in patients with hepatic disorders and leukemia. The study reports for the first time the involvement of C. dubliniensis in yeast fungemia occurring in Saudi Arabia.     

Septic Shock Induced From An Implantable Cardioverter-Defibrillator Lead-Associated Candida albicans Vegetation

In recent years, the use of implantable cardioverter-defibrillators has made a significant impact in the treatment of cardiac disease. With the advent of this therapy, infection has become a growing concern, with a reported incidence of 1–11%. Although device-related infections are most frequently caused by bacterial pathogens, fungal etiologies are uncommon and carry an exceedingly high mortality rate. To date, there is only one published report of an implantable cardioverter-defibrillator lead-associated infection secondary to Candida albicans. This case report presents the second such case. A review of the literature regarding fungal endocarditis as well as diagnosis and therapy of this rare and dangerous disease is discussed.     

Case Report. Acremonium falciforme fungemia in a patient with acute leukaemia

We describe a case of Acremonium falciforme fungemia under treatment of fluconazole. A. falciforme is a common saprophyte. This fungus has been isolated from a patient's specimen, and the organism may have contributed to his death.