2016~2017年河北地区侵袭性真菌感染的病原菌分布特征

中国真菌学杂志　 2019, Vol. 14 　Issue (5): 257-263.

2016~2017年河北地区侵袭性真菌感染的病原菌分布特征

栗方¹, 李志荣², 赵建宏², 赵颖³, 张延海⁴, 董爱英⁵, 刘金禄⁶, 郭彦言⁷, 孙艳⁸, 赵文申⁹, 谢守军¹⁰, 魏宏莲¹¹, 张金艳¹², 任宏涛¹³, 王建升¹⁴, 吴相锟⁴, 光晓¹⁵, 刘冬青¹⁶, 杜红丽¹⁷, 郭映辉¹⁸, 徐英春³, 肖盟³, 杨文航³, 徐晓琳⁴

1. 河北燕达医院感染与疾病控制部, 廊坊 065201;首都医科大学附属北京朝阳医院感染与微生物科, 北京 100020;
2. 河北医科大学第二医院河北省临床检验中心, 石家庄 050000;
3. 中国医学科学院北京协和医院检验科侵袭性真菌病机制研究与精准诊断北京市重点实验室, 北京 100730;
4. 河北燕达医院, 廊坊 065201;
5. 华北理工大学附属医院, 唐山 063000;
6. 河北北方学院附属第一医院, 张家口 075000;
7. 河北省唐山市工人医院, 唐山 063000;
8. 沧州市中心医院, 沧州 061001;
9. 邯郸市中心医院, 邯郸 056001;
1
0. 承德医学院附属医院, 承德 067000;
1
1. 河北医科大学第二医院, 石家庄 050000;
1
2. 河北医科大学第四医院, 石家庄 050019;
1
3. 邢台市人民医院, 邢台 054001;
1
4. 河北省人民医院, 石家庄 050057;
1
5. 河北省武安市第一人民医院, 武安 056300;
1
6. 邯郸市第一医院, 邯郸 056002;
1
7. 衡水市人民医院, 衡水 053000;
1
8. 河北省儿童医院, 石家庄 050030

收稿日期:2019-06-13 出版日期:2019-10-28 发布日期:2019-10-28
通讯作者: 赵建宏,E-mail:1543838793@qq.com;赵颖,E-mail:zhaoying28062806@163.com E-mail:1543838793@qq.com;zhaoying28062806@163.com
作者简介:栗方,女(汉族),大学本科,副主任技师.E-mail:lifang280@sohu.com
基金资助:
河北省科技计划-重点研发计划项目资助（17277775D）；中央高校基本科研业务费专项资金资助项目（3332018041）；辉瑞中国抗真菌科研基金项目资助（WS931592）

Distribution characteristics of invasive fungal infections in Hebei province from 2016 to 2017

LI Fang¹, LI zhi-rong², ZHAO Jian-hong², ZHAO Ying³, ZHANG Yan-hai⁴, DONG Ai-ying⁵, LIU Jin-lu⁶, GUO Yan-yan⁷, SUN Yan⁸, ZHAO Wen-shen⁹, XIE Shou-jun¹⁰, WEI Hong-lian¹¹, ZHANG Jin-yan¹², REN Hong-tao¹³, WANG Jian-sheng¹⁴, WU Xiang-kun⁴, GUANG Xiao¹⁵, LI Dong-qing¹⁶, DU Hong-li¹⁷, GUO Ying-hui¹⁸, XU Ying-chun³, XIAO Meng³, YANG Wen-Hang³, XU Xiao-lin⁴

1. Herbei Yanda hopstial, Langfang 065201;Chao yang Hospital Affilliated to the Capital University of Medical Science, Beijing 100020, China;
2. Clinical Laboratory Center of Hebei Province, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China;
3. Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China;
4. Herbei Yanda hopstial, Langfang 065201;
5. North China University of Science and Technology Affiliated Hospital, Tangshan 063000;
6. The First Affiliated Hospital of Hebei North University School of Clinical Medicine, Zhangjiakou 075000;
7. Department of Endocrinology, Tangshan Gongren Hospital, Tangshan 063000;
8. Cangzhou Central Hospital, Cangzhou 061001;
9. The Central Hospital of Handan, Handan 056001;
1
0. Affiliated Hospital of Chengde Medical College, Chengde 067000;
1
1. The Second Hospital of Hebei Medical University, Shijiazhuang 050000;
1
2. Fourth Hospital Affiliated to Hebei Medical University, Shijiazhuang 050019;
1
3. People's Hospital of Xingtai City, Xingtai 054001;
1
4. Hebei Provincial People's Hospital, Shijiazhuang 050057;
1
5. The First People's Hospital of Wu'an City, Wuan 056300;
1
6. Handan First People's Hospital, Handan 056002;
1
7. People's Hospital of Hengshui City, Hengshui 053000;
1
8. Hebei Children's Hospital, Shijiazhuang 050030

Received:2019-06-13 Online:2019-10-28 Published:2019-10-28

摘要/Abstract

摘要：

目的了解2016~2017年河北地区16家三级教学医院侵袭性真菌感染现状，为临床诊治和感染防控提供数据资料。方法各参与单位收集引起侵袭性真菌感染的酵母菌和丝状真菌菌株，中心实验室应用Vitek MS质谱分析进行菌株复核鉴定，对Vitek MS不能有效鉴定的疑难和罕见菌株采用ITS和/或钙调蛋白CaM测序分析。结果 16家医院共检出侵袭性真菌493株，其中酵母菌268株（54.36%），丝状真菌225株（45.64%）。酵母菌主要是白念珠菌41.79%，其次是热带念珠菌、近平滑念珠菌和光滑念珠菌。丝状真菌主要是烟曲霉58.22%，其次是黄曲霉/米曲霉和黑曲霉。侵袭性真菌复核正确率（373/493）75.66%。结论引起的侵袭性真菌感染中最常见的是念珠菌为主的酵母菌和曲霉菌为主的丝状真菌。采用微生物质谱鉴定结合ITS/CaM区测序方法可以有效提高真菌的鉴定正确率，为临床侵袭性真菌的治疗提供参考依据。

关键词: 侵袭性真菌, 酵母菌, 丝状真菌, 分布特征

Abstract:

Objective To expore distribution characteristics of invasive fungal infections in 16 tertiary teaching hospitals in Hebei from 2016 to 2017, and to provide data for clinical diagnosis, treatment and infection control. Methods The yeast fungi and filamentous fungi causing invasive fungal infections were collected by member units. The strains were re-examined by Vitek MS analysis in the central laboratory. For difficult and rare strains, ITS and/or calmodulin CaM sequencing were used. Results A total of 493 invasive fungi strains were detected in 16 hospitals from 2016 to 2017, including 268 yeast fungi (54.36%) and 225 filamentous fungi (45.64%). Yeast fungi include 112 strains of C. albicans (41.79%), 52 strains of C. tropicalis (19.40%), 38 strains of C. parapsilosis (14.18%), 29 strains of C. glabrata (10.82%), 10 strains of Cryptococcus neoformans (3.73%) and 27 strains of other Candida (10.07%). Filamentous fungi included 131 strains of Aspergillus fumigatus (58.22%), 24 strains of Aspergillus flavus/Aspergillus oryzae (10.67%), 18 strains of Aspergillus Niger (8.00%), 6 strains of Aspergillus sydowii (2.67%), 5 strains of Aspergillus nestoris (2.22%) and 41 strains of other filamentous fungi (18.22%). The correct rate of invasive fungi identification was 75.66% (373/493). Conclusion The most common invasive fungal infections were Candida-dominated yeasts and Aspergillus-dominated filamentous fungi. The combination of microbial mass spectrometry identification and ITS/CaM region sequencing could effectively improve the identification accuracy of fungi and provide a reference for clinical treatment of invasive fungi.

Key words: invasive fungi, yeast fungi, filamentous fungi, distribution characteristics

中图分类号:

R379

栗方, 李志荣, 赵建宏, 赵颖, 张延海, 董爱英, 刘金禄, 郭彦言, 孙艳, 赵文申, 谢守军, 魏宏莲, 张金艳, 任宏涛, 王建升, 吴相锟, 光晓, 刘冬青, 杜红丽, 郭映辉, 徐英春, 肖盟, 杨文航, 徐晓琳. 2016~2017年河北地区侵袭性真菌感染的病原菌分布特征[J]. 中国真菌学杂志, 2019, 14(5): 257-263.

LI Fang, LI zhi-rong, ZHAO Jian-hong, ZHAO Ying, ZHANG Yan-hai, DONG Ai-ying, LIU Jin-lu, GUO Yan-yan, SUN Yan, ZHAO Wen-shen, XIE Shou-jun, WEI Hong-lian, ZHANG Jin-yan, REN Hong-tao, WANG Jian-sheng, WU Xiang-kun, GUANG Xiao, LI Dong-qing, DU Hong-li, GUO Ying-hui, XU Ying-chun, XIAO Meng, YANG Wen-Hang, XU Xiao-lin. Distribution characteristics of invasive fungal infections in Hebei province from 2016 to 2017[J]. Chinese Journal of Mycology, 2019, 14(5): 257-263.

参考文献

[1] 陶家驹.侵袭性肺真菌感染诊治的现状及前景[J]. 中国全科医学,2007,10(7):524-526.
[2] Guimarães T, Nucci M, Mendonça JS, et al. Epidemiology and predictors of a poor outcome in elderly patients with candidemia[J]. Int J Infect Dis,2012,16(6):e442-e447.
[3] Sipsas NV, Kontoyiannis DP. Invasive fungal infections inpatients with cancer in the Intensive Care Unit[J].Int J Antimicrob Agents,2012,39(6):464-471.
[4] 钟南山, 叶枫.深部真菌感染:新的挑战与展望[J].中华结核和呼吸杂志,2006(29):289-290.
[5] 刘善收,杨婧,梁晓丽等.2013-2017年急诊重症监护室侵袭性真菌病临床分析[J].临床急诊杂志,2017,18(7):511-514.
[6] 周颖杰,李光辉.2009年美国感染病学会念珠菌病处理指南解读[J].中国循证医学杂志,2016,16(1):20-25.
[7] Balajee SA, Borman AM, Brandt ME, et al. Sequence-based identification of Aspergillus, Fusarium and Mucorales species in the clinical mycology laboratory:where are we and where should we go from here[J]. J Clin Microbiol, 2009, 47(4):877-884.
[8] Ying Li, He Wang, Yu-Pei Zhao,et al. Evaluation of the Bruker Biotyper matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system for identification of Aspergillus species directly from growth on solid agar media[J]. Front Microbiol, 2017, 29(8):1209.
[9] 中华人民共和国卫生部.侵袭性真菌病临床实验室操作指南.中华人民共和国卫生行业标准.WS/T497-2017[S].中华人民共和国卫生部,2017.
[10] 中华医学会呼吸病学分会感染学组.中华结核和呼吸杂志编辑委员.肺真菌病诊断和治疗专家共识[J].中华结核和呼吸杂志, 2007, 30(11):821-834.
[11] 林桂兰,马晓波,房丽丽,等.(1,3)-β-D葡聚糖连续监测在抗真菌药物治疗中的评价[J].中华医院感染学杂志,2016,26(1):37-39.
[12] 王贺,徐英春.中国多中心侵袭性酵母菌感染临床相关科学研究方法体系的探索和建立[D].北京协和医学院,2017.
[13] M Xiao,ZY Sun,M Kang,et al. Five-year national surveillance of invasive candidiasis:species distribution and azole susceptibility from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study[J]. J Clin Microbiol,2018,56(7).e00577-18.
[14] 马庆林,单万水.深圳地区侵袭性真菌感染的菌种分类及分布情况[J].深圳中西医结合杂志,2018,28(14):1-3.
[15] V Adámková, A Vaňková, Ulrych J, et al. Characterisation of Candida sp. isolated from patients after abdominal surgery[J]. Rozhledy v chirurgii:msíník eskoslovenské chirurgické spolenosti, 2017, 96(10):426-431.
[16] 林松发,李红宾.侵袭性念珠菌病的研究进展[J].实用临床医学,2015,16(9):100-105.
[17] 栗方, 王龙, 曹彬. 侵袭性肺曲霉菌体外药敏试验与分子鉴定及基因分型研究[J].中华医院感染学杂志, 2014, 24(6):1301-1303.
[18] Li F, Wang B, Wang L, et al. Phylogenetic analyses on the diversity of Aspergillus fumigatus sensu lato based on five orthologous Loci[J]. Mycopathologia, 2014, 178(3-4):163-176..
[19] 张乐研,闫丽红,杨蕙.38例患者感染丝状真菌的临床调查[J].中国消毒学杂志,2017,34(7):650-652.
[20] Li F, Wu L, Cao B, et al. Surveillance of the prevalence, antibiotic susceptibility, and genotypic characterization of invasive candidiasis in a teaching hospital in China between 2006 to 2011[J]. BMC Infectious Diseases, 2013, 13(1):353-361.
[21] 栗方, 赵颖, 赵建宏, 等. 河北地区侵袭性酵母样真菌感染的分布特征[J].中华医院感染学杂志, 2018, 28(18):2761-2765.
[22] Wang H,Fan YY,Kudinha T,et al.A comprehensive evaluation of the Bruker Biotyper MS and Vitek MS matrix-assisted laser desorption lonization-time of flight mass spectrometry systems for identification of yeasts,part of the National China Hospital Invasive Fungal Surveillance NET(CHIF-NET)study,2012 to 2013[J].J Clin Microbiol, 2016,54(5):1376-1380.
[23] Wang H,Liu Y,Chen SC,et al.Chaetomium atrobrunneum and Aspergillus fumigatus in multiple tracheal aspirates:Copathogens or symbiosis[J].J Microbiol Immunol Infect, 2016,49(2):281-285.
[24] Wang H,Chen YL,Teng SH,et al.Evaluation of the Bruker Biotyper matrix-assisted laser desorption/lonization time-of-flight mass spectrometry system for identification of clinical and environmental isolates of Burkholderia pseudomallei[J].Front Microbiol,2016,7:415.