Etiological analysis on ocular fungal infection in the period of 1989-2000

Background This study was to review the distribution and shifting trend of fungal of culture specimens isolated from eyes of patients at the Beijing Institute of Ophthalmology, Tongren Hospital, Beijing, China.Methods The fungal culture-positive rate, the distribution and change of isolates of 2609 specimens collected in a 12-year period (1989-2000) were retrospectively analyzed.Results In 775 positive cultures, 707 specimens (91.2%) were from the cornea, 22 (2.8%) from the conjunctiva, 15 (1.9%) from the anterior chamber, 9 (1.2%) from the vitreous body, 3 (0.4%) from the lacrimal sac, and 19 (2.5%) from other parts of the eye. The average culture-positive rate was 29.7%. The ratio of the positive cultures in the first half year (from January to June) to those in the second half (from July to December) was 1∶2.1. The main genus cultured was Fusarium sp (58.7%), followed by Aspergirum sp (16.8%). The percentage of Fusarium sp was increased from 53.6% (1989-1994) to 60.2% (1995-2000), whereas the percentage of Aspergirum sp was decreased from 22.3% (1989-1994) to 15.1% (1995-2000). Conclusions Fusaruim sp is one of the most predominant pathogens of ocular fungal infection in northern China and its incidence tends to increase, but that of Aspergirum sp to decrease. It is very important to recognize the distribution and shifting trend of pathogenic fungi in the diagnosis, prevention and treatment of fungal keratitis.

系统性红斑狼疮伴真菌感染的病原学特点、耐药性及危险因素分析

目的探讨系统性红斑狼疮伴真菌感染的病原学特点、耐药性,并分析其危险因素。方法回顾性分析该院78例系统性红斑狼疮伴真菌感染患者的临床资料,行病原菌与耐药性试验,并针对影响系统性红斑狼疮伴真菌感染的相关因素行多因素Logistic回归分析。结果 554例系统性红斑狼疮患者有78例发生真菌感染,占14.08%;感染部位中,呼吸道、泌尿生殖道感染发生率较高,分别占29.49%、25.64%。78例患者中真菌培养结果共发现102株真菌,其中白色假丝酵母菌与新生隐球菌分别占总数的52.94%、31.37%。通过多因素Logistic回归分析显示,住院时间>4周、24h尿蛋白水平≥3.5g、器官损伤累及数≥3个、抗菌药物应用时间≥2周及白细胞计数≥3×109/L、CD4+≤200个/微升、补体C3<0.8mg/L均是影响其感染的独立危险因素。结论影响系统性红斑狼疮伴真菌感染因素较多,临床应根据其感染部位及感染真菌类型,选择不同的药物进行治疗,以提高治疗有效率,同时还应根据影响因素加强防范,以降低其发生率。

105例侵袭性真菌感染患者临床分析

目的分析105例侵袭性真菌感染(IFI)患者的病原菌和临床特征,为临床诊断和治疗提供借鉴。方法采用回顾性病例分析的方法,收集2011年1月-2014年12月医院门诊和住院IFI患者的病例资料,纳入标准为经活检组织病理学检查确诊。结果 92.4%病例为院外获得性感染,52.4%病例无IFI危险因素,手术取材、CT引导下穿刺和内镜下活检是主要的确诊手段,IFI病原菌以曲霉为主占54.3%,其次为毛霉占8.6%、隐球菌占4.8%和假丝酵母菌占3.8%;33.3%IFI病例伴有肺部侵犯,但胸部影像学和临床表现的特征性不强;73.3%病例经手术清除病灶,26.7%病例使用抗真菌药物治疗,其中6例接受手术和抗真菌联合治疗;7例死亡或治疗无效。结论积极开展有创性检查、早期诊断、手术清除病灶和针对性抗真菌治疗可以降低IFI患者的病死率。

老年肺癌患者肺部真菌感染的病原学分析

目的研究老年肺癌患者侵袭性肺部真菌感染的致病菌及药敏结果,为临床提高对疾病的认识提供参考。方法回顾性分析2011年1月-2014年1月96例肺癌发生侵袭性肺部真菌感染的老年患者的临床资料,统计肺癌患者真菌感染的病原菌种类及药敏结果,数据均应用SPSS 21.0进行统计处理,分析患者发生感染的危险因素。结果 96例肺癌真菌感染患者共分离出107株病原菌,以白色假丝酵母菌居多占63.55%,6种抗真菌药物中耐药率最高的为伊曲康唑27.10%,影响肺癌患者罹患侵袭性肺部真菌感染的危险因素有75岁以上高龄、吸烟史、功能状态不佳、化疗后联合放疗、化疗周期2次以上及白细胞减少。结论肺癌侵袭性肺部真菌感染的致病菌以白色假丝酵母菌、热带假丝酵母菌为主;常用抗真菌药物耐药率较小的分别为氟胞嘧啶、两性霉素B等。