Brown R S, Lake J R, Katzman B A, Ascher N L, Somberg K A, Emond J C, Roberts J P
Department of Medicine, University of California Medical Center, San Francisco, 94143, USA.
Transplantation. 1996 Feb 27;61(4):666-9. doi: 10.1097/00007890-199602270-00029.
Aspergillus infection is a rare but devastating complication following solid organ transplantation, with mortality rates that approach 100%. Aspergillus species (sp) are also ubiquitous in our environment and may contaminate culture plates. To determine the significance of positive Aspergillus cultures, we analyzed all positive cultures from the liver and kidney transplant services at our center for the treatments used and clinical outcomes. Aspergillus sp. were cultured from 4.5% of liver and 2.2% of kidney transplant recipients. A. fumigatus was the most common isolate, followed by A. niger and A. flavus. The lung was the most common site of positive cultures. Body fluids (ascites, pleural fluid) were common sources of positive cultures but were never associated with clinical disease. Positive brain biopsies occurred in 10% of patients. Analysis of risk factors for significant infection revealed that cultures with >2 colonies or more than one site of infection were predictive of significant infection and portended a poor prognosis even with aggressive therapy. Two or fewer colonies from a single site likely represented contamination and may be followed with repeat cultures. The high mortality rate associated with Aspergillus sp. infections in transplant recipients highlights the need for better anti-fungal prophylaxis and treatment.
曲霉感染是实体器官移植后一种罕见但极具破坏性的并发症，死亡率接近100%。曲霉菌种在我们的环境中也普遍存在，可能会污染培养皿。为了确定曲霉菌培养阳性的意义，我们分析了本中心肝脏和肾脏移植科室所有培养阳性病例的治疗方法及临床结果。4.5%的肝移植受者和2.2%的肾移植受者培养出曲霉菌种。烟曲霉是最常见的分离菌株，其次是黑曲霉和黄曲霉。肺部是培养阳性最常见的部位。体液（腹水、胸水）是培养阳性的常见来源，但从未与临床疾病相关。10%的患者脑活检呈阳性。对严重感染的危险因素分析显示，培养菌落数>2个或感染部位不止一处可预测严重感染，即使积极治疗预后也较差。单个部位菌落数为两个或更少可能表示污染，可通过重复培养进行追踪。移植受者中与曲霉菌种感染相关的高死亡率凸显了更好地进行抗真菌预防和治疗的必要性。
