泉州市某医院133例临床隐球菌病病原菌分离、药敏试验及临床分析

There were 133 cases of clinical analysis of clinicalcryptococcal disease, isolation of pathogenic bacteria and drugsusceptibility testing in a hospital in Quanzhou

目的:对比泉州市某医院感染HIV与未感染HIV隐球菌病患者的临床特点、抗生素治疗以及药敏试验等,为诊断和治疗提供参考。方法:回顾性分析2012-2022年泉州市某三甲医院检出的隐球菌病患者133例,均为新生隐球菌,其中HIV阳性组54例,HIV阴性组79例,对临床表现、治疗、预后及实验室检查和药敏结果进行分析。结果:133例患者中,HIV阳性组男性患者比例较高。两组年龄差异无统计学意义。HIV阳性组出现头痛、发热、恶心呕吐的患者多于HIV阴性组。HIV阳性组的全血标本多于HIV阴性组,HIV阴性组的痰液、灌洗液标本多于HIV阳性组。药敏结果显示,所有菌株对两性霉素B、伏立康唑敏感率均为100%;仅有7株对5-氟胞嘧啶耐药及各有4株对氟康唑和伊曲康唑耐药。HIV阳性组使用两性霉素B联合5-氟胞嘧啶治疗的患者多于HIV阴性组,HIV阴性组使用氟康唑治疗的患者多于HIV阳性组,两组患者的转归差异无统计学意义。结论:泉州市某医院感染HIV与未感染HIV隐球菌病患者的临床资料、临床表现及抗生素治疗比较有显著差异,因此早期检查对于病变的判断与处理非常关键,避免造成漏诊、误诊。

Objective:The clinical characteristics,antibiotic treatment and drug susceptibility test of patients infected with HIV and uninfected with HIV in a tertiary hospital in Quanzhou City were compared to provide reference for diagnosis and treatment.Methods:A retrospective analysis was performed on 133 cases of cryptococcal disease detected in a tertiary hospital in Quanzhou from 2012 to 2022,all of which were Cryptococcus neoformans,including 54 cases in the HIV-positive group and 79 cases in the HIV-negative group,and the clinical manifestations,treatment,prognosis,laboratory tests and drug susceptibility results were analyzed.Results:Among the 133 patients,the proportion of male patients in the HIV-positive group was high.There was no significant difference in age between the two groups.Patients in the HIV-negative group have more underlying medical conditions such as hypertension,diabetes,and cirrhosis.More patients in the HIV-positive group had headache,fever,nausea and vomiting than in the HIV-negative group.The HIV-positive group had more whole blood samples than the HIV-negative group,and the HIV-negative group had more sputum and lavage samples than the HIV-positive group.The susceptibility results showed that all strains had a sensitivity rate of 100%to amphotericin B and voriconazole.Only 7 strains were resistant to 5-fluorocytosine and 4 strains each were resistant to fluconazole and itraconazole.There were no significant differences in outcomes between the HIV-positive group than with amphotericin B plus 5-flucytosine in the HIV-positive group and fluconazole in the HIV-negative group than with fluconazole.Conclusion:There were significant differences in clinical data,clinical manifestations and antifungal therapy of HIV-infected and uninfected patients with HIV-infected cryptococcal disease in a hospital in Quanzhou,so early detection is very important for the judgment and treatment of lesions to avoid missed diagnosis and misdiagnosis.