某部队医院2013-2018年真菌血流感染菌种分布和耐药性分析

 目的 调查医院真菌血流感染状况,为真菌血流感染的预防和治疗提供参考。方法 对某部队医院2013-2018年真菌血流感染的检测结果进行回顾性分析,对感染真菌种类、科室分布及耐药性状况进行分析。结果 共分离真菌血流感染菌株97株, 30.93%为白色念珠菌,但由2013年的41.67%,下降至2018年的27.78%,呈现下降趋势。真菌血流感染的主要科室为血液科(24.74%)和重症医学科(22.68%)。97株真菌对4种抗菌药物的敏感率:氟胞嘧啶97.80%、伏立康唑97.80%、氟康唑93.30%、伊曲康唑71.10%。结论 血流感染真菌以白色念珠菌为主,但非白色念珠菌感染有上升趋势;提高患者免疫力,减少有创性检查和治疗是减少真菌血流感染的重要环节;三唑类药是抗真菌药的主力军,在治疗过程中需要检测其耐药性的变化。     

Prevention and treatment of Candida infections in neonates

Invasive Candia infections have become the third most common cause of late-onset infection among very low birth weight infants in most neonatal intensive care units. Significant risk factors include birth weight less than 1000 g, exposure to more than two antibiotics, third generation cephalosporin exposure, parenteral nutrition including lipid emulsion, central venous catheter, and abdominal surgery. The majority of neonatal Candida infections are caused by C. albicans and C. parapsilosis, although other nonalbicans species are being reported more frequently. Standard therapy has been amphotericin B; however, successful use of fluconazole as a single agent has also been reported and a small comparison trial demonstrated similar efficacy. The addition of new antifungal agents, including voriconazole and the echinocandins may further improve our ability to effectively treat these infections and possibly reduce the development of complications. Antifungal chemoprophylaxis has been studied in single-center and cohort studies, primarily using fluconazole. Although it is clear that fluconazole prophylaxis decreases the risk of fungal colonization and infection, identification of potential harm, particularly the development of or selection for resistant strains, requires further investigation with multicenter trials before widespread use is recommended outside of the clinical trial setting.     

Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements

Because of widespread use of probiotics, their safety must be guaranteed. We assessed use of Saccharomyces boulardii probiotic yeast from medical records for patients who had Saccharomyces fungemia or other clinical Saccharomyces culture findings. We evaluated all Saccharomyces sp. findings at 5 university hospitals in Finland during 2009–2018. We found 46 patients who had Saccharomyces fungemia; at least 20 (43%) were using S. boulardii probiotic. Compared with a control group that had bacteremia or candidemia, the odds ratio for use of an S. boulardii probiotic was 14 (95% CI 4–44). Of 1,153 nonblood culture findings, the history for 125 patients was checked; at least 24 (19%) were using the probiotic (odds ratio 10, 95% CI 3–32). This study adds to published fungemia cases linked to use of S. boulardii probiotic and sheds light on the scale of nonblood Saccharomyces culture findings that are also linked to use of this probiotic.     

不同免疫功能患者合并热带念珠菌败血症的危险因素及疗效分析

目的探讨不同免疫功能患者合并热带念珠菌败血症的危险因素及疗效。方法回顾性分析44例经血培养证实为热带念珠菌败血症的患者的临床资料。结果44例热带念珠菌败血症患者中,基础疾病存在免疫功能低下者30例（68．2％）,免疫功能正常者14例（31．8％）;免疫功能低下患者合并热带念珠菌败血症的危险因素主要是中性粒细胞缺乏、广谱抗生素的应用,免疫功能正常患者主要是留置导管;免疫功能低下组和免疫功能正常组抗真菌治疗的总有效率分别为60．9％、78．6％,两组比较差异有统计学意义（P〈0．05）;免疫功能低下组感染相关死亡率为43．3％,明显高于免疫功能正常组（7．1％,P〈0．05）。结论热带念珠菌败血症的预后与患者的免疫功能密切相关。     

Disseminated infection with Trichosporon asahii

Summary. Trichosporon fungaemia and disseminated, purpuric, papular skin lesions developed on the head, trunk and extremities of a 5-year-old female with acute lymphocytic leukaemia. Histopathologically, the skin lesions demonstrated dermal budding yeasts. She died despite treatment with antifungal drugs. The isolate from the blood was further identified morphologically and physiologically as Trichosporon asahii , based on the revision of the genus Trichosporon by Guého et al. (1992). According to the new revision. T. asahii is the only taxon regularly involved in systemic mycoses, so that most of the isolates previously reported as T. beigelii (formerly, T. cutaneum ) in human deep mycoses are now thought to belong to T. asahii.
Zusammenfassung. Bei einem fünfjährigen Mädchen mit akuter lymphatischer Leukämie entwickelte sich eine Trichosporon -Fungämie mit disse-minierten, papulösen Hautläsionen und Purpura an Kopf, Stamm und Extremitäten. Histopathologisch wurden in den Hautläsionen sprossende Hefezellen nachgewiesen. Die Patientin verstarb trotz antimykotischer Chemotherapie. Der aus dem Blut isolierte Erreger wurde als Trichosporon asahii identifiziert. Im von Guého et al. revidierten Genus Trichosporon ist T. asahii die einzige Art, die regelmäßig an der Entstehung systemischer Mykosen beteiligt ist. Die meisten der bisher aus tiefen Mykosen des Menschen isolierten Trichosporon -Stämme, die früher als T. beigelii bzw. T. cutaneum bezeichnet wurden, werden nunmehr als zu T. asahii gehörend angesehen.     

急性白血病并发播散性热带念珠菌血症的临床分析

[目的]提高对急性白血病(AL)并发播散性热带念珠菌血症临床特征的认识。[方法]回顾性分析3例AL并发播散性热带念珠菌血症临床表现、诊治过程和转归。[结果]在3例患者中,中性粒细胞(ANC)缺乏时出现持续发热、鹅口疮;B超均发现肝内类圆形或椭圆形多发低回声,血培养均示热带念珠菌生长。3例患者采用两性霉素B(AmpB)联合5氟胞嘧啶治疗后体温正常。[结论]AL并发播散性热带念珠菌血症的诊断需结合病史、临床表现、实验室检查及影像学检查综合判断;选用两性霉素B联合5氟胞嘧啶治疗有较好的临床疗效。     

危重病科念珠菌血症23例临床分析

目的探讨ICU危重症患者念珠菌血症的临床特点及其防治策略。方法回顾性分析我院ICU念珠菌血症患者的临床资料。结果23例院内获得性感染患者中血培养共获得念珠菌菌株23株,其中白色假丝酵母菌12株（52.2%）,非白色假丝酵母菌11株（47.8%）。使用广谱抗生素18例,中心静脉置管16例,高龄15例,腹部手术10例,ICU住院＞7天19例,气管插管13例,急性生理慢性健康评分（APACHEⅡ）≥20分14例。血清降钙素原（PCT）含量为（0.58±0.25） μg/L,(1,3) β D 葡聚糖（G实验）为（210.1±147.9） ng/L。15例患者给予卡泊芬净。总病死率47.8%。结论念珠菌血症仍以白色念珠菌感染为主,多发生于具有多种易感因素者。对高危患者应重视PCT和G实验检测及病原学检查,及时合理选用抗真菌药物。     

Skin lesion in a patient after hematopoietic stem cell transplant

We present a case of a 61‐year‐old Caucasian woman who was hospitalized with fever on day 176 after a matched unrelated stem cell transplant for acute myelogenous leukemia. She developed hemorrhagic bullae on the skin of her right thigh, and both blood cultures and skin biopsy confirmed Fusarium proliferatum. Despite antifungal therapy, her condition worsened and she died while on comfort‐only measures.