Department of Dermatology , General Hospital of Beijing Military Command ; The Clinical Medical College in the Beijing Military Region of Second Military Medical University of People's Liberation Army.
Department of Dermatology , General Hospital of Beijing Military Command.
Open Forum Infect Dis. 2015 Sep 25;2(4):ofv141. doi: 10.1093/ofid/ofv141. eCollection 2015 Dec.
Background. Trichosporon species have emerged as an important non-Candida spp yeast pathogen in immunocompromised patients in recent decades; however, the systemic analysis of Trichosporon epidemiology has seldom been reported. Methods. We reviewed 185 reported cases of Trichosporon fungemia from 1975 to 2014 in the English-language literature, and the epidemiology and prognostic factors of the included cases are described. Results. The number of cases reported has increased with time, especially over the past decade. During the 3 decades from 1975 to 2004, the most commonly used antifungal compounds were amphotericin B/liposomal amphotericin B; however, in recent decades (2005-2014), triazoles (especially voriconazole) have become the most widely used agents, significantly improving outcome in the reported cases. Correlation analysis revealed that negative outcome is associated with several prognostic factors, including a history of antimicrobial use, bacterial bloodstream coinfection, prophylactic/empirical antifungal therapy, Trichosporon beigelii infection, and receiving the antifungal regimen of amphotericin B/liposomal amphotericin B. In addition, a significantly greater proportion of patients with a positive outcome had fungemia without invasive tissue infection and received a voriconazole regimen or an AmB-triazole combined regimen. Significant positive outcome was also associated with patients who had recovered from neutropenia or after central venous catheter removal. Conclusions. Voriconazole can be recommended as a first-line antifungal compound to treat Trichosporon fungemia; the immune status of the host plays a crucial role in the outcome of this infection, and the removal of vascular catheters should be considered if feasible.
近年来，在免疫功能低下患者中， Trichosporon 种已成为一种重要的非念珠菌属酵母病原体；然而，Trichosporon 流行病学的系统分析鲜有报道。
我们回顾了 1975 年至 2014 年间在英文文献中报道的 185 例 Trichosporon 菌血症病例，并描述了所纳入病例的流行病学和预后因素。
报告的病例数量随时间增加，尤其是在过去十年中。在 1975 年至 2004 年的 30 年中，最常用的抗真菌药物是两性霉素 B/脂质体两性霉素 B；然而，在最近几十年（2005-2014 年），三唑类（尤其是伏立康唑）已成为最广泛使用的药物，显著改善了报告病例的预后。相关性分析表明，不良预后与多种预后因素相关，包括抗菌药物使用史、细菌血流感染、预防性/经验性抗真菌治疗、感染 Trichosporon beigelii 和接受两性霉素 B/脂质体两性霉素 B 抗真菌治疗。此外，阳性预后患者中，无侵袭性组织感染且接受伏立康唑治疗方案或两性霉素 B-三唑类联合治疗方案的患者比例显著更高。中性粒细胞减少症恢复或中心静脉导管移除后，患者也有显著良好的预后。
可以推荐伏立康唑作为治疗 Trichosporon 菌血症的一线抗真菌药物；宿主的免疫状态在该感染的预后中起着关键作用，如果可行，应考虑移除血管导管。
