Álvarez-Uría Ana, Guinea Jesus Vicente, Escribano Pilar, Gómez-Castellá Javier, Valerio Maricela, Galar Alicia, Vena Antonio, Bouza Emilio, Muñoz Patricia
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain.
Mycoses. 2020 Nov;63(11):1195-1202. doi: 10.1111/myc.13154. Epub 2020 Sep 9.
Non-Aspergillus mould infections such as those caused by Scedosporium apiospermum or Lomentospora prolificans are an emerging threat. Few studies have monitored their long-term incidence.
To analyse the epidemiology, risk factors, clinical features and incidence of patients with proven and probable infections.
PATIENTS/METHODS: Patients admitted to Gregorio Marañón Hospital between 1998 and 2017 and from whom Scedosporium/Lomentospora was isolated were studied. Subjects were classified as having a probable/proven invasive fungal infection or colonization. Molecular identification and antifungal susceptibility testing of isolates causing infection were performed, as well as a description of the patients and incidence of infection.
One or more Scedosporium/Lomentospora isolates were identified in 67 patients. Sixteen (23.9%) patients had developed infection: 11 scedosporiosis and 5 lomentosporiosis. Stable incidence was observed throughout the study period. Most patients were immunosuppressed and the most common underlying diseases were haematologic malignancy (25%), solid organ transplantation (25%) and chronic corticoid therapy (25%). Breakthrough infection occurred in four patients, 2/11 (18.2%) cases of scedosporiosis and 2/5 (40%) of lomentosporiosis. Overall mortality was 54.5% (6/11) and 80% (4/5) in subjects with scedosporiosis and lomentosporiosis, respectively. High MICs of amphotericin B and remarkable inter-species susceptibility variability to triazoles was observed for most isolates.
In contrast to previous studies, the incidence of scedosporiosis and lomentosporiosis has not increased at our hospital over the years. The tendency to cause disseminated infection and a reduced susceptibility to most antifungal agents leads to high mortality.
非曲霉菌霉菌感染，如由波氏足分支霉或多育卷枝霉引起的感染，是一种新出现的威胁。很少有研究监测它们的长期发病率。
分析确诊和疑似感染患者的流行病学、危险因素、临床特征及发病率。
患者/方法：对1998年至2017年间入住格雷戈里奥·马拉尼翁医院且分离出足分支霉属/卷枝霉属的患者进行研究。受试者被分类为患有疑似/确诊的侵袭性真菌感染或定植。对引起感染的分离株进行分子鉴定和抗真菌药敏试验，并对患者情况及感染发病率进行描述。
在67例患者中鉴定出一株或多株足分支霉属/卷枝霉属。16例（23.9%）患者发生感染：11例足分支霉病和5例卷枝霉病。在整个研究期间观察到发病率稳定。大多数患者免疫功能低下，最常见的基础疾病是血液系统恶性肿瘤（25%）、实体器官移植（25%）和长期使用皮质类固醇治疗（25%）。4例患者发生突破性感染，足分支霉病患者中有2/11（18.2%），卷枝霉病患者中有2/5（40%）。足分支霉病和卷枝霉病患者的总体死亡率分别为54.5%（6/11）和80%（4/5）。大多数分离株对两性霉素B的最低抑菌浓度较高，对三唑类药物的种间药敏差异显著。
与之前的研究相比，多年来我院足分支霉病和卷枝霉病的发病率并未增加。导致播散性感染的倾向以及对大多数抗真菌药物敏感性降低导致死亡率较高。
