热带念珠菌所致血流感染的临床及实验室分析

摘要/Abstract

摘要： 目的通过对热带念珠菌所致血流感染的临床特征及实验室检查结果进行分析，为临床预防及诊治提供一定的参考依据。方法收集2018年1月至2020年12月四川大学华西医院热带念珠菌血流感染患者的临床资料，回顾性统计分析患者的临床特征及实验室检查结果等。结果 27例热带念珠菌血流感染患者均有基础疾病且伴有2种及以上危险因素，（1，3）-β-D-葡聚糖试验对辅助诊断热带念珠菌血流感染有很好的灵敏度，其余炎性指标如超敏C反应蛋白、降钙素原、白细胞介素-6均有不同程度增高;27株热带念珠菌对唑类抗真菌药物的敏感率依次为伊曲康唑（77.8%）、伏立康唑（48.2%）、氟康唑（48.2%）、泊沙康唑（37.0%），对两性霉素B、卡泊芬净、米卡芬净敏感率均是100%。结论热带念珠菌血流感染常发生于有基础疾病且合并多种危险因素的患者，针对临床高危患者，应及时完善实验室检查以明确诊断;热带念珠菌对唑类药物的敏感性较差，临床治疗时应重视药敏结果、合理用药、及时控制患者症状。

关键词: 热带念珠菌, 血流感染, 临床特征, 实验室检查

Abstract: Objective To analyze the clinical characteristics and laboratory results of bloodstream infection caused by Candida tropicalis in order to provide reference for clinical and prevention. Methods The clinical data of patients with bloodstream infection caused by Candida tropicalis in West China Hospital Sichuan University from January 2018 to December 2020 were collected, and the related clinical characteristics and laboratory examination of the patients were analyzed retrospectively. Results The 27 patients with bloodstream infection caused by Candida tropicalis had basic diseases and two or more risk factors. (1,3)-β-D-glucan test had a good sensitivity in the auxiliary diagnosis of Candida tropicalis bloodstream infection. Other inflammatory indexes such as high sensitive C-reactive protein, procalcitonin and interleukin-6 were increased in varying degrees.The sensitivity rates of 27 strains of Candida tropicalis to azole antifungal drugs were itraconazole(77.8%),voriconazole(48.2%), fluconazole(48.2%), posaconazole(37.0%). The sensitivity rate to amphotericin B, caspofungin and micafungin was 100%. Conclusion Candida tropicalis bloodstream infection often occured in patient with underlying diseases and a variety of risk factors Candida tropicalis had poor sensitivity to azole drugs, so we should pay attention to drug sensitivity results in clinical treatment.

Key words: Candida tropicalis, bloodstream infection, clinical characteristics, laboratory examination

中图分类号:

R379.4

成微, 邓劲, 刘雅, 舒玲, 陈知行, 戴仲秋, 康梅. 热带念珠菌所致血流感染的临床及实验室分析[J]. 中国真菌学杂志, 2022, 17(2): 99-102,114.

CHENG Wei, DENG Jing, LIU Ya, SHU Ling, CHEN Zhixing, DAI Zhongqiu, KANG Mei. Clinical and laboratory analysis of bloodstream infection caused by Candida tropicalis[J]. Chinese Journal of Mycology, 2022, 17(2): 99-102,114.

参考文献

[1] 彭敏飞,厉世笑,朱士土,等.成人白色念珠菌与非白色念珠菌血流感染相关危险因素分析[J].中国检验杂志,2020,30(15):1888-1891.
[2] TAN B H, CHAKRABARTI A, LI R Y, et al. Incidence and species distribution of candidaemia in Asia:a laboratory-based surveillance study[J]. Clin Microbiol Infect,2015,21(10):946-953.
[3] DA MATTA D A, SOUZA A C R, COLOMBOA L. Revisiting species distribution and antifungal susceptibility of Candida bloodstream isolates from Latin American MedicalCenters[J]. J Fungi (Basel),2017,3(2):24.
[4] MEGRI Y, ARASTEHFAR A, BOEKHOUT T, et al. Candida tropicalis is the most prevalent yeast species causing candidemia in Algeria:the urgent need for antifungal stewardship and infection control measures[J]. Antimicrob Resist Infect Control, 2020,9(1):50.
[5] XIAO M, CHEN S C, KONG F,et al.Distribution and antifungal susceptibility of Candida species causing candidamia in China:An update from the CHIF-NET study[J]. J Infect Dis,2020,221(Suppl 2):S139-S147.
[6] CLSI. M60:Performance standards for antifungal susceptibility testing of yeasts[S].1st ed.Wayne,PA:Clinical and Laboratory Standards Institute,2017.
[7] CLSI.M59:Epidemiological cut off values for antifungal susceptibility testing[S].2nd ed.Wayne,PA:Clinical and Laboratory Standards Institute,2018.
[8] 于垚,何慧倩,吴梦雪,等.念珠菌与宿主相互作用的研究进展[J].菌物学报,2020,39(11):2088-2108.
[9] TEO J Q, CANDRA S R, LEE S J,et al.Candidemia in a major regional tertiary referral hospital-epidemiology, practice patterns and outcomes[J]. Antimicrob Resist Infect Control, 2017 6(1):27-37.
[10] FERNÁNDEZ-RUIZ M, PUIG-ASENSIO M, GUINEA J. Candida tropicalis bloodstream infection:Incidence, risk factors and outcome in a population-based surveillance[J]. J Infect, 2015,71(3):385-394.
[11] MIKULSKA M, DEL BONO V,RATTO S,et al.Occurrence, presentation and treatment of candidemia[J].Expert Rev Clin Immunol, 2012,8(8):755-765.
[12] 王贺.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[D]. 北京:北京协和医学院,2017.
[13] 宗来斌,吕火烊.G试验联合真菌培养在假丝酵母菌血流感染诊治中的价值[J].中国微生态学杂志,2020,32(6):660-665.
[14] 杨金,朱均昊,李莉,等.(1,3)-β-D葡聚糖检测联合其他微生物学检测在侵袭性真菌病诊断中的相关性分析[J].中国感染与化疗志,2020,20(3):277-281.
[15] 张艺,郭磊磊,高延秋.真菌血流感染患者病原菌分布及血生化指标水平[J].中华医院感染学杂志,2020,30(14):2086-2089.
[16] 应芙蓉,陈约慧,石亮,等.血浆(1,3)-β-D-葡聚糖及血清降钙素原等炎性指标在真菌性血流感染中的作用[J].中国卫生检验杂志,2017,27(4):563-566.
[17] 井然,侯欣,肖盟,等.中国侵袭性真菌耐药监测网成员单位重症监护室侵袭性酵母的分布特征及其对唑类药物敏感性的变迁[J].中国感染与化疗杂志,2020,20(2):175-180.
[18] 左微.热带念珠菌血症的临床特点及预后因素分析[D].重庆:重庆医科大学,2019.
[19] 顾迟,陈功祥,周宏伟,念珠菌对唑类药物耐药性及耐药机制的研究进展[J].临床药物治疗杂志,2010,8(3):44-48.
[20] 王影,项明洁,刘锦燕,等. ERG11基因与热带念珠菌唑类药物耐药性关系的研究[J].中国真菌学杂志,2019,14(6):332-337.
[21] FAN X,XIAO M,ZHANG D,et al. Molecular mechanisms of azole resistance in Candida tropicalis isolates causing invasive candidiasis in China[J]. Clin Microbiol Infect, 2019, 25(7):885-891.
[22] 应芙蓉,朱华,赵志照,等. 白色念珠菌菌株的生物膜形成率及其对抗真菌类药物的敏感性[J].中国临床药理学杂志,2017,33(21):2131-2134.
[23] KAWAI A, YAMAGISHI Y, MIKAMO H. Time-lapse tracking of Candida tropicalis biofilm formation and the antifungal efficacy of liposomal amphotericin B[J]. Jpn J Infect Dis, 2017,70(5):559-564.