Xia Jinxing, Wang Zhongxin, Li Tingting, Lu Fanbo, Sheng Daping, Huang Wei
Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, People's Republic of China.
Department of Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, People's Republic of China.
Infect Drug Resist. 2022 Feb 2;15:321-333. doi: 10.2147/IDR.S351260. eCollection 2022.
Since the nosocomial fungal infections increasingly emerge, we extensively investigated the fungal species stratification and antifungal sensitivity profiles, clinical characteristics and associated risk factors of immunosuppressed patients with clinically diagnosed invasive fungal infections (IFIs) in a tertiary hospital of Anhui province.
In total, 112 subjects with immunosuppressive state were enrolled from a comprehensive tertiary hospital in Central China between July 2019 and December 2021. Eight-one fungal isolates were clinically recovered by fungus-culturing approaches. The identifications were conducted through a mass spectrometry detecting platform. The susceptibilities to antifungals were tested using the broth micro-dilution method, and the possible antifungal azole-resistance mechanism in specific species was availably explored by sequencing. Patient medical profiles were accessed via the digitized retrieval system of hospital, from which clinical outcomes and multiple risk factors for immunosuppressed patients with clinically diagnosed IFIs were explicitly documented for evaluation.
species predominated in clinically diagnosed IFIs of immunosuppressed patients (accounting for 88.88%), followed by and species (6.17% and 4.94%, respectively). The source types of specimen were primarily comprised of urine (41.98%), respiratory samples (33.33%) and peripheral blood (9.88%). Frequently isolated and species exhibited a high level of in vitro sensitivity for amphotericin B and 5-fluorocytosine, whereas a substantial portion of species including complex and , and species showed lowered sensitivity patterns toward itraconazole, fluconazole and voriconazole at different levels. Specifically, gene mutations of were identified in azole-resistant . Distinct risk factors were analyzed to be highly associated with the clinically diagnosed IFI incidence, mainly including hospitalization duration, surgical procedures, immunosuppressive treatments, underlying diseases and other conditions.
and species were the top three pathogenic fungal agents causing clinically diagnosed IFIs in immunosuppressed patients. The attenuated sensitivity to azoles in and species needs close surveillance, and polymorphism might contribute to azole resistance in specific species. Multiple featured risk factors for immunosuppressed patients developing clinically diagnosed IFIs require further consideration during clinical practice.
鉴于医院内真菌感染日益增多，我们对安徽省一家三级医院临床诊断为侵袭性真菌感染（IFI）的免疫抑制患者的真菌种类分层、抗真菌敏感性谱、临床特征及相关危险因素进行了广泛调查。
2019年7月至2021年12月，从华中地区一家综合性三级医院招募了112例免疫抑制状态的受试者。通过真菌培养方法临床分离出81株真菌菌株。通过质谱检测平台进行鉴定。采用肉汤微量稀释法检测对抗真菌药物的敏感性，并通过测序有效探索特定物种中可能的抗真菌唑耐药机制。通过医院数字化检索系统获取患者病历，明确记录免疫抑制患者临床诊断为IFI的临床结局和多种危险因素进行评估。
属在免疫抑制患者临床诊断的IFI中占主导地位（占88.88%），其次是 属和 属（分别占6.17%和4.94%）。标本来源类型主要包括尿液（41.98%）、呼吸道样本（33.33%）和外周血（9.88%）。经常分离出的 属和 属对两性霉素B和5-氟胞嘧啶表现出较高的体外敏感性，而包括 复合体和 属在内的大部分 属以及 属对伊曲康唑、氟康唑和伏立康唑表现出不同程度的较低敏感性。具体而言，在唑耐药的 中鉴定出 基因突变。分析了与临床诊断的IFI发病率高度相关的不同危险因素，主要包括住院时间、手术、免疫抑制治疗、基础疾病和其他情况。
属、 属和 属是导致免疫抑制患者临床诊断IFI的前三大致病真菌病原体。 属和 属对唑类药物敏感性减弱需要密切监测， 基因多态性可能导致特定 属对唑类耐药。免疫抑制患者发生临床诊断IFI的多种特征性危险因素在临床实践中需要进一步考虑。
