Zeng Xuehua, Peng Mengran, Liu Guirong, Huang Yongqing, Zhang Tingting, Wen Jing, Lai Wei, Zheng Yue
Clinical Laboratory, The Third Affiliated Hospital of Sun Yat-sen University-Yuedong Hospital, Meizhou, China.
Department of Dermatology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Bioeng Biotechnol. 2021 Feb 11;8:625024. doi: 10.3389/fbioe.2020.625024. eCollection 2020.
Patients with systemic internal diseases present high risks for invasive fungal infections, which results in increased morbidity and mortality. Identification of high-risk departments and susceptibility systems could help to reduce the infective rate clinically. Correct selection of sensitive anti-fungal drugs not only could improve the cure rate but also could reduce the adverse reactions and complications caused by long-term antifungal drug treatment, which can be especially important in patients with serious systemic diseases. Therefore, the distribution changes of invasive fungal strains in patients with systemic internal diseases and the choice of antifungal drugs in clinical practice should be updated.
This work aimed to investigate the incidence, strain distributions, and drug susceptibility of invasive fungal strains isolated from patients with systemic internal diseases.
Samples were collected from 9,430 patients who were diagnosed with internal diseases in our hospital from January to December 2018. We then cultured and identified the fungal strains using API 20C AUX. We performed drug sensitivity analysis the ATB Fungus-3 fungal susceptibility strip. Resistance was defined using the revised Clinical Laboratory Standardization Committee of United States breakpoints/epidemiological cutoff values to assign susceptibility or wild-type status to systemic antifungal agents.
A total of 179 patients (49 female, 130 male) with fungal infection were included. The high-incidence departments were determined to be the respiratory department (34.64%), intensive care unit (ICU; 21.79%), and hepatology department (9.50%). The susceptible systems for infection were the respiratory tract (sputum, 68.72%, 123/179; secretion retained in the tracheal catheter, 3.35%, 6/179), urinary tract (urine, 9.50%, 17/179), and gastrointestinal tract (feces, 9.50%, 17/179). The major pathogens were (90.50%), (8.93%), and (0.56%). The infective candida subgroups were (70.95%), (6.15%), (5.59%), (3.91%), and (3.91%). The susceptibility of non- fungi for amphotericin B was 100.0%. The susceptibility rates of 5-fluorocytocine (5-FC) and voriconazole were 72.73 and 81.82%, respectively, for , 98.43 and 100% for , and 100% for both drugs for , , and . The susceptibility rates of fluconazole and itraconazole were 0 and 54.55%, respectively, for , 20 and 20% for , and 57.14 and 57.14% for . The resistance rate of for both fluconazole and itraconazole was 41.43%.
Patients in the respiratory department, ICU, and hepatology department presented high rates of invasive fungal infections and should include special attention during clinical treatment. The respiratory tract, urinary tract, and gastrointestinal tract were the susceptible systems. , especially , was the main pathogen. From the perspective of drug sensitivity, amphotericin B should be given priority in treating the non- fungi infection in patients with systemic internal diseases, while the susceptibility of invasive fungal strains to azoles was variant. These data might provide clinical evidence for the prevention and treatment of invasive fungal infection in patients with systemic internal diseases.
患有全身性内科疾病的患者发生侵袭性真菌感染的风险较高，这会导致发病率和死亡率增加。识别高危科室和易感染部位有助于在临床上降低感染率。正确选择敏感的抗真菌药物不仅可以提高治愈率，还可以减少长期抗真菌药物治疗引起的不良反应和并发症，这对于患有严重全身性疾病的患者尤为重要。因此，应更新全身性内科疾病患者侵袭性真菌菌株的分布变化及临床实践中抗真菌药物的选择。
本研究旨在调查从全身性内科疾病患者中分离出的侵袭性真菌菌株的发病率、菌株分布及药物敏感性。
收集2018年1月至12月在我院诊断为内科疾病的9430例患者的样本。然后使用API 20C AUX对真菌菌株进行培养和鉴定。我们使用ATB Fungus-3真菌药敏试纸进行药敏分析。根据美国临床实验室标准化委员会修订的断点/流行病学截断值来定义耐药性，以确定全身性抗真菌药物的敏感性或野生型状态。
共纳入179例真菌感染患者（49例女性，130例男性）。确定高发病科室为呼吸科（34.64%）、重症监护病房（ICU；21.79%）和肝病科（9.50%）。易感染部位为呼吸道（痰液，68.72%，123/179；气管导管内潴留分泌物，3.35%，6/179）、泌尿道（尿液，9.50%，17/179）和胃肠道（粪便，9.50%，17/179）。主要病原菌为白色念珠菌（90.50%）、热带念珠菌（8.93%）和光滑念珠菌（0.56%）。感染的念珠菌亚组为白色念珠菌（70.95%）、热带念珠菌（6.15%）、近平滑念珠菌（5.59%）、光滑念珠菌（3.91%）和季也蒙念珠菌（3.91%）。非白色念珠菌对两性霉素B的敏感性为100.0%。5-氟胞嘧啶（5-FC）和伏立康唑对白色念珠菌的敏感率分别为72.73%和81.82%，对热带念珠菌分别为98.43%和100%，对近平滑念珠菌、光滑念珠菌和季也蒙念珠菌这两种药物的敏感率均为100%。氟康唑和伊曲康唑对白色念珠菌的敏感率分别为0和54.55%，对热带念珠菌分别为20%和20%，对近平滑念珠菌分别为57.14%和57.14%。白色念珠菌对氟康唑和伊曲康唑的耐药率均为41.43%。
呼吸科、ICU和肝病科患者侵袭性真菌感染率较高，临床治疗中应予以特别关注。呼吸道、泌尿道和胃肠道是易感染部位。白色念珠菌，尤其是白色念珠菌，是主要病原菌。从药敏角度看，全身性内科疾病患者非白色念珠菌感染治疗应优先选用两性霉素B，而侵袭性真菌菌株对唑类药物的敏感性存在差异。这些数据可为全身性内科疾病患者侵袭性真菌感染的防治提供临床依据。
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