我院妇科门诊女性生殖道真菌感染的病原学特点及药敏分析

目的:了解贵阳地区女性生殖道真菌感染的病原学特点及对抗真菌药的耐药性,为临床治疗提供参考。方法:采用科玛嘉念珠菌显色培养基及ATB Expression自动细菌鉴定仪进行病原菌的鉴定,用ATB Fungus 3药敏试验卡进行体外药敏试验。结果:我院妇科门诊498例女性生殖道真菌感染率为34.9%,感染病原菌以白色念珠菌及光滑念珠菌所占比例较高,分别占52.3%、24.4%。病原菌对5种抗真菌药均存在不同程度的耐药性,以两性霉素B的耐药率最低,伊曲康唑耐药率最高。结论:该地区女性生殖道真菌感染病原菌构成多样,不同病原菌对抗真菌药的耐药性相差较大。临床应加强女性生殖道真菌感染的病原学和耐药性监测,根据药敏试验结果合理使用抗真菌药。     

医院内泌尿系真菌感染的调查研究

目的对可疑泌尿系统真菌感染患者的尿液进行培养鉴定,了解患者泌尿系统真菌感染状况,为临床真菌感染的诊断提供病原学依据,指导治疗。方法按常规方法培养,沙堡弱培养基培养24h,将有酵母菌生长的标本接种于科玛嘉念珠菌显色培养基进行培养鉴定。结果440例标本中,真菌菌株51例,阳性率为11.59%;以白色念珠菌最多,占45%,依次为克柔念珠菌(18%),热带念珠菌(16%),光滑念珠菌(14%)等;科室分布以内分泌科发病率最高,占20%。结论医院内泌尿系真菌感染仍以白色念珠菌为主,各科室均有院内泌尿系真菌感染,发病年龄以老年人多见,女性多于男性。     

156例真菌鉴定及耐药性分析

目的了解156例真菌感染的菌群分布及耐药状况,为临床治疗提供依据。方法用TTC沙氏培养基进行真菌培养,采用珠海市丽拓发展有限公司生产的真菌分离、鉴定、药敏检测一体化试剂盒,对真菌进行分离鉴定和药敏试验。结果156例真菌感染中,以白色念珠菌为主,占71.8%,药敏结果显示,真菌对5-氟胞嘧啶、两性霉素B、制霉菌素敏感率较高,均在90%以上,而对咪康唑、依曲康唑、氟康唑、酮康唑敏感率较低。结论真菌感染主要由白色念珠菌、热带念珠菌、光滑念珠菌引起,5-氟胞嘧啶、两性霉素B、制霉菌素是治疗真菌感染的首选药物。     

肺结核合并真菌感染病原菌检验分析

目的：了解肺结核合并真菌感染的病原菌种类、特点与分布,为临床用药提供合理依据。方法将本院2011年1月~2013年2月期间收治的50例肺结核合并真菌感染患者呼吸道样本以孵箱内培养后作真菌鉴定检验。结果经培养鉴定检验后,检出5种真菌群,白假丝酵母菌有52株,占58.4%;热带念珠菌13株,占14.6%;光滑念珠菌9株,占10.1%;克柔念珠菌7株,占7.9%;曲霉菌8株,占9.0%。结论及时将肺结核患者下呼吸道样本做真菌培养涂片鉴定,找到菌丝,可为临床治疗肺结核合并真菌感染患者提供早期预防、诊断依据。     

论真菌耐药性的发展与研究

自1970年开始,真菌感染发病率逐年上升。80年代以前,因为真菌感染发生率相对较低,抗真菌药物的品种有限和这些抗真菌药物的副作用较大,临床应用较少,因此抗真菌药物的耐药性产生和发展较慢,只有少数较罕见的真菌如部分克柔念珠菌、光滑念珠菌、葡萄牙念珠菌、白杰尔毛孢子菌对AmB耐药。     

科玛嘉念珠菌显色培养基的临床应用

目的探讨科玛嘉（CHROMagar）念珠菌显色培养基的临床应用。方法对106份可疑为真菌感染的标本分别采用CHROMagar念珠菌显色培养基鉴定和沙氏培养基ATB鉴定,比较2种方法的结果和符合率。结果 106份标本共检出念珠菌59株,其中白色念珠菌35株（59.3%）,热带念珠菌9株（15.3%）,光滑念珠菌占7株（11.9%）,克柔念珠菌2株（3.4%）,其他菌株6株（10.2%）。2种方法鉴定4种念珠菌总体符合率为98.1%,鉴定结果比较差异无统计学意义（P〉0.05）。结论 CHROMagar念珠菌显色培养基鉴定念珠菌的菌型,具有操作简便、快速、准确的特点,适合临床微生物室推广使用。     

156例COPD患者肺部真菌感染临床诊断分析

目的 分析慢性阻塞性肺疾病(COPD)患者肺部真菌感染的临床诊断。方法分析我院2012年1月至2014年1月确诊为COPD患者156例痰液标本,培养3次,使用CAN-DIFAST真菌鉴定系统予以鉴定。结果 156例痰真菌阳性COPD患者,白色念珠菌91例,热带念珠菌16,光滑念珠菌22例,克柔念珠菌10例,毛霉菌9例,酵母样真菌8例;药敏分析方面,真菌对于多种抗真菌药物的敏感率比较高。结论 COPD患者肺部真菌感染呈现出逐年上升趋势,其中主要为白色念珠菌,两性霉素B以及氟胞嘧啶等药物临床上有较为理想的治疗效果。     

140株真菌感染标本的鉴定及药敏分析

目的分析商丘市中心医院真菌感染及药敏情况,为临床预防及治疗真菌感染提供参考依据。方法对临床分离的140株真菌标本进行鉴定及药物敏感性试验。结果 140株真菌有14个种,以念珠菌属为主,其中白色念珠菌的检出率居首。140株真菌的药敏结果,以两性霉素B、制霉菌素的作用最强;氟康唑的耐药率最高。结论真菌感染呈上升趋势,并产生了一定的耐药性。     

76例肺癌患者深部真菌感染病原菌分析

以形态学、芽管试验、科玛嘉念珠菌显色培养基、API20CAUX仪对肺癌患者深部真菌感染的病原菌进行鉴定分析;病原真菌白念珠菌占49.38%,非白念珠菌所占44.45%;白念珠菌仍然是最常见的致病真菌,但所占的比例已下降,而非白念珠菌占的比例明显增加,存在着菌种变迁的趋势。     

探讨临床常见真菌分布的特点及药敏试验

目的了解呼吸道真菌感染和药敏测试情况。方法收集患者标本850株对其检出的240株真菌选用常用6种真菌药敏感测试。结果通过痰液涂片及分离培养,白色念珠菌为主要致病菌,对6种抗真菌药均敏感,只有克柔念珠菌对氟康唑耐药。结论临床应重视对真菌感染的分离鉴定和药敏测试。     

念珠菌引起深部感染的病原学特征与药敏试验

目的了解近年来深部念珠菌感染的病原学特征和医院内深部真菌感染现状,为临床提供病原学诊断和合理使用抗真菌药物的依据。方法血培养使用BacT ALERT 3D血培养检测仪,其他各种临床标本用沙堡培养基培养,科玛嘉念珠菌显色培养基分离鉴定念珠菌;用ATB Fungus 2药敏卡对菌株进行体外药物敏感试验。结果3年间从深部标本中共分离出念珠菌2256株,菌种分布依次为:白色念珠菌(72.61%)、光滑念珠菌(10.28%)、克柔念珠菌(9.40%)、热带念珠菌(4.97%)、其他念珠菌(2.74%);162株念珠菌药敏结果:5-氟胞嘧啶、两性霉素对所有念珠菌敏感度都很高,但各种真菌对4种抗真菌药物均出现了不同程度的耐药。结论白色念珠菌仍为主要的致病真菌,但非白色念珠菌所占比例有逐年上升的趋势。不同念珠菌对常用抗真菌药物敏感性存在差异,准确分离鉴定和药敏试验,对指导临床医生合理用药有重要意义。     

聚合酶链反应限制性片段长度多态性快速检测模拟尿标本中致病念珠菌的研究

目的研究常见的致病性念珠菌的分子生物学鉴定方法,为深部念珠菌的分子诊断奠定基础。方法用白色念珠菌、热带念珠菌、净平滑念珠菌和克柔念珠菌的标准菌株制备模拟尿标本,对其核糖体DNA内转录间隔区进行聚合酶链反应扩增,对扩增产物进行内切酶MspⅠ的酶切分析。结果4种念珠菌经聚合酶链反应后产生4种不同分子量的条带,扩增产物经酶切后产生4种特异性带型。结论聚合酶链反应—限制性片段长度多态分析方法是一种可靠、稳定、特异的鉴定常见致病念珠菌的方法。     

临床4种常见念珠菌及其药物敏感性分析

目的：常见念珠菌种类的临床分析及其对4种抗真菌药物的耐药性。方法：统计近年来临床标本分离的念珠菌并对其进行5-氟胞嘧啶（5-Fc）、两性霉素-B（AMB）、氟康唑（FCA）、伊曲康唑（ITR）的药敏分析。结果：所有分离菌株中白色念珠菌占比最高,为60.1%,其次为光滑念珠菌（20.5%）,热带念珠菌（10.9%）,克柔念珠菌（4.5%）。体外药敏试验显示AMB和5-Fc对临床常见念珠菌具有比较高的敏感性。结论：白色念珠菌仍是目前第一位感染菌,但非白色念珠菌也不容忽视。不同念珠菌的耐药性存在种间差异。     

Developments in the treatment of candidiasis: more choices and new challenges

The incidence of oesophageal candidiasis, candidaemia and disseminated candidiasis has increased dramatically. In addition to the amphotericin B formulations and fluconazole, the echinocandins anidulafungin, caspofungin and micafungin and the newer triazoles posaconazole and voriconazole are in the last stages of development and are becoming available for the management of candidiasis. This review presents these new agents and addresses their role in the treatment of candidiasis. All new antifungal agents exhibit potent activity against Candida spp. and echinocandins are fungicidal against most Candida spp. but appear to be less potent against certain species, such as Candida parapsilosis and C. guilliermondii. Systemic antifungal therapy can now be individualised based on the severity of the infection, comorbid conditions and the Candida spp. causing the infection. Studies are needed to investigate the possible development of resistance and the efficacy of these antifungal agents against the more resistant Candida spp.     

Criteria used when initiating antifungal therapy against Candida spp. in the intensive care unit

Invasive candidiasis is a life threatening complication for intensive care unit (ICU) patients. The infection is difficult to recognise so that treatment may be delayed or even not given. Risk factors for candidiasis include the use of antimicrobial agents, central intravascular devices (mainly Hickmann catheters), recurrent gastrointestinal perforations, surgery for acute pancreatitis or splenectomy and renal dysfunction or haemodialysis. Therapy against Candida spp is recommended in ICU patients with endophthalmitis or chorioretinitis possibly caused by Candida spp., in symptomatic patients with risk factors for invasive candidiasis especially if two or more anatomical sites are colonised and for asymptomatic high-risk surgical patients (with recent abdominal surgery or recurrent gastrointestinal perforations or anastomotic leakages). The isolation of Candida from any site poses an increased risk but there are a few microbiological data that might help to establish the predictive value of a particular isolate. These include the site of isolation, the number of culture positive, noncontigous sites, the density of colonisation and the species isolated. Antifungals should be started when Candida spp. are recovered from blood cultures or from usually sterile body fluids, abscesses or wounds in burns patients. They should also be considered in patients with a colonisation index >0.5 or a corrected colonization index >0.4 or when the isolate is identified as Candida tropicalis.     

Genitourinary fungal infections: a therapeutic conundrum

Fungi cause 8% of nosocomial infections. This is caused, in part, by the increasing pool of immunocompromised patients. Elderly, transplant and HIV patients, as well as premature infants, have become prime candidates for invasive fungal infections. The widespread use of broad spectrum antibiotics plays a role. Utilisation of appropriate antifungal treatment modalities requires an understanding of the pathogenesis of infection. This is a challenging problem as fungi can cause different clinical manifestations that depend on the type of fungal species and patient response to the infection. Although Candida spp. are the most frequent pathogen, other species such as Aspergillus and Cryptococcus have become major pathogens. Environmental fungi which include Blastomyces, Coccidioides and Histoplasma have become more aggressive in the vulnerable patient. The genitourinary system can be a source or target of disseminated fungal infection. Diagnosis depends on clinical awareness, utilisation of appropriate diagnostic modalities, imaging modalities and a thorough clinical assessment. The treatment of primary (Blastomyces, Coccidioides, Histoplasma) infection generally requires amphotericin B (AmpB). The opportunistic infections (Aspergillus, Cryptococcus and Candida) may respond to the triazoles although AmpB remains the 'gold standard'. Infections caused by Candida spp. represents the greatest challenge to the clinician. The presence of Candida spp. in the urine may indicate colonisation or infection. Untreated, Candida can remain as a 'saprophyte' or develop ascending infection, sepsis or death. The prophylactic use of fluconazole may in itself result in resistant infection, hence the 'conundrum'.     

Pharmacotherapy of yeast infections

The rise of immunocompromised individuals in our society has provoked a significant emergence in the number of patients affected by opportunistic pathogenic yeast. The microorganisms with a major clinical incidence are species from the genera Candida (especially Candida albicans) and Cryptococcus (particularly Cryptococcus neoformans), although there has been a significant increase in other pathogenic yeasts, such as Trichosporon spp. and Rhodotorula spp. In addition, there are an increasing number of patients infected by yeasts that were not previously considered as pathogenic, such as Saccharomyces cerevisiae. The management of these infections is complicated and is highly dependent on the susceptibility profile not only of the species but also of the strain. The available antifungal compounds belong mainly to the polyene, azole and candin families, which show a distinct spectrum of activity. This review summarizes the current knowledge about the use of the main antifungals for treating infections caused by the yeast species with the most significant clinical relevance, including the susceptibility profiles exhibited by these species in vitro.     

Genitourinary fungal infections: a therapeutic conundrum

Fungi cause 8% of nosocomial infections. This is caused, in part, by the increasing pool of immunocompromised patients. Elderly, transplant and HIV patients, as well as premature infants, have become prime candidates for invasive fungal infections. The widespread use of broad spectrum antibiotics plays a role. Utilisation of appropriate antifungal treatment modalities requires an understanding of the pathogenesis of infection. This is a challenging problem as fungi can cause different clinical manifestations that depend on the type of fungal species and patient response to the infection. Although Candida spp. are the most frequent pathogen, other species such as Aspergilla and Cryptococcus have become major pathogens. Environmental fungi which include Blastomyces, Coccidioides and Histoplasma have become more aggressive in the vulnerable patient. The genitourinary system can be a source or target of disseminated fungal infection. Diagnosis depends on clinical awareness, utilisation of appropriate diagnostic modalities, imaging modalities and a thorough clinical assessment. The treatment of primary (Blastomyces, Coccidioides, Histoplasma) infection generally requires amphotericin B (AmpB). The opportunistic infections (Aspergilla, Cryptococcus and Candida) may respond to the triazoles although AmpB remains the ‘gold standard’. Infections caused by Candida spp. represents the greatest challenge to the clinician. The presence of Candida spp. in the urine may indicate colonisation or infection. Untreated, Candida can remain as a ‘saprophyte’ or develop ascending infection, sepsis or death. The prophylactic use of fluconazole may in itself result in resistant infection, hence the ‘conundrum’.     

Epidemiology of Candida albicans infections and role of non-Candida-albicans yeasts

Infections of the skin and the mucous membranes due to Candida species may occur either in immuncompromised or in non-immuncompromised patients. This is in contrast to systemic candidiasis (e.g. candidemia) which is only seen in severely immunocompromised patients. Bloodstream infections caused by Candida species are increasingly recognized in critical ill adult and pediatric individuals, with significant associated morbidity and mortality. Candida albicans is the single most common fungal species causing nosocomial infections. However, non-Candida albicans spp., including fluconazole-less-susceptible Candida glabrata, have become more common pathogens. In some patient populations such as hematological (neutropenic) patients Non-C. albicans species are detected much more frequently as compared to non-neutropenic patients in the intensive care. Non-C. albicans species are more likely to occur in patients, who receive or have received antifungal therapy with azoles (e.g. fluconazole). In this review the current epidemiological trends in mucosal and invasive candidiasis are discussed with regard to the role of non-Candida albicans species as the causative agent in immunocompromised patients.     

Invasive fungal infections in patients with cancer in the Intensive Care Unit

Invasive fungal infections (IFIs) have emerged as a major cause of morbidity and mortality amongst critically ill patients. Cancer patients admitted to the Intensive Care Unit (ICU) have multiple risk factors for IFIs. The vast majority of IFIs in the ICU are due to Candida spp. The incidence of invasive candidiasis (IC) has increased over recent decades, especially in the ICU. A shift in the distribution of Candida spp. from Candida albicans to non-albicans Candida spp. has been observed both in ICUs and oncology units in the last two decades. Timely diagnosis of IC remains a challenge despite the introduction of new microbiology techniques. Delayed initiation of antifungal therapy is associated with increased mortality. Therefore, prediction rules have been developed and validated prospectively in order to identify those ICU patients at high risk for IC and likely to benefit from early treatment. These rules, however, have not been validated in cancer patients. Similarly, major clinical studies on the efficacy of newer antifungals typically do not include cancer patients. Despite the introduction of more potent and less toxic antifungals, mortality from IFIs amongst cancer patients remains high. In recent years, aspergillosis and mucormycosis have also emerged as significant causes of morbidity and mortality amongst ICU patients with haematological cancer.