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某种邪恶之物正朝这边而来:医疗服务提供者需要了解的关于……

Something wicked this way comes: What health care providers need to know about .

作者信息

Schwartz I S, Smith S W, Dingle T C

机构信息

Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB.

Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB.

出版信息

Can Commun Dis Rep. 2018 Nov 1;44(11):271-276. doi: 10.14745/ccdr.v44i11a01.

Abstract

is a fungal pathogen that recently emerged and rapidly spread around the globe. It is now in Canada. can cause invasive disease with high mortality rates, is frequently resistant to one or more classes of antifungals, and can be difficult to identify in some clinical microbiology laboratories. can also involve prolonged colonization of patients' skin and contamination of surrounding environments, resulting in nosocomial outbreaks in hospitals and long-term care facilities. Clinicians, infection prevention and control practitioners and public health officials should be aware of how to mitigate the threat posed by this pathogen. Index cases of should be suspected in patients with invasive candidiasis and recent hospitalization in global regions where is prevalent, as well as in patients who fail to respond to empiric antifungal therapy and from whom unidentified or unusual Candida species have been isolated. If a case of infection or colonization is identified or suspected, the following should take place: notification of local public health authorities and infection prevention and control practitioners; placement of colonized or infected patients in single rooms with routine contact precautions; daily and terminal environmental disinfection with a sporicidal agent; contact tracing and screening for transmission; and referral of suspicious or confirmed isolates to provincial laboratories. Patients with symptomatic disease should be treated with an echinocandin pending the results of antifungal susceptibility testing, preferably in consultation with an infectious disease specialist. Through the vigilance of front-line health care workers and microbiologists, robust infection prevention and control practices, and local and national surveillance efforts, can be detected quickly, infections managed and transmissions prevented to protect patients in our health care system.

摘要

是一种最近出现并在全球迅速传播的真菌病原体。它现在已在加拿大出现。可导致侵袭性疾病,死亡率很高,经常对一种或多种抗真菌药物耐药,并且在一些临床微生物实验室中可能难以鉴定。还可导致患者皮肤长期定植以及周围环境污染,从而在医院和长期护理机构引发医院感染暴发。临床医生、感染预防与控制从业人员以及公共卫生官员应了解如何减轻这种病原体所构成的威胁。在侵袭性念珠菌病且近期在该病原体流行的全球地区住院的患者中,以及在经验性抗真菌治疗无效且分离出未鉴定或不常见念珠菌属的患者中,应怀疑存在该病原体的索引病例。如果确定或怀疑有该病原体感染或定植病例,应采取以下措施:通知当地公共卫生当局和感染预防与控制从业人员;将定植或感染患者安置在单人房间,并采取常规接触预防措施;每天和终末使用杀孢子剂进行环境消毒;进行接触者追踪和该病原体传播筛查;以及将可疑或确诊的分离株转诊至省级实验室。有症状疾病的患者应在抗真菌药敏试验结果出来之前接受棘白菌素治疗,最好咨询传染病专家。通过一线医护人员和微生物学家的警惕、强有力的感染预防与控制措施以及地方和国家监测工作,可以迅速检测到该病原体,控制感染并防止传播,以保护我们医疗系统中的患者。

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