念珠菌血症的临床特征及其与(1,3)-β-D葡聚糖的关系
|
摘要
目的了解念珠菌血症患者的菌种分布、临床特征,分析其与(1,3)-β-D-葡聚糖之间的关系。方法收集暨南大学附属五邑中医院2015年9月-2018年3月31例念珠菌血症患者、39例念珠菌深部定植患者、50名健康人,结合患者真菌培养情况、临床资料、各组血浆(1,3)-β-D-葡聚糖水平进行分析。结果 31例念珠菌血症患者血培养分离出13株白念珠菌和18株非白念珠菌。念珠菌血症与患者年龄(>65岁)、7 d内有手术史、体内留置导管情况(≥2根,≥5d)、机械通气持续时间(≥5d)有关(P<0.05),与性别、基础疾病、抗生素和抗真菌药物使用情况、免疫抑制剂或糖皮质激素使用情况、低蛋白血症无关(P>0.05)。念珠菌血症患者的血浆(1,3)-β-D-葡聚糖水平显著高于念珠菌深部定植组和健康对照组(P<0.05),其诊断念珠菌血症的灵敏度和特异度分别为87.1%和96.0%。合并细菌感染念珠菌血症组(1,3)-β-D-葡聚糖水平显著高于单一念珠菌血症感染组(P<0.05),单一白念珠菌血症组的(1,3)-β-D-葡聚糖水平也显著高于单一非白念珠菌血症组(P<0.05)。结论念珠菌血症病原菌中虽然非白念珠菌感染多于白念珠菌,但白念珠菌仍是最常见的单一念珠菌菌种。念珠菌血症易发生在高龄(>65岁)、7d内有手术史、体内留置导管(≥2根,≥5d)、机械通气(≥5d)的患者中。(1,3)-β-D-葡聚糖在念珠菌血症中有早期辅助诊断价值。
Objective To understand the etiology and clinical characteristics of candidemia, and the diagnostic value of(1,3)-β-Dglucan. Methods This analysis included 31 patients with candidemia, 39 patients with Candida deep colonization, and 50 healthy subjects, who were enrolled from Wuyi Chinese Hospital Affiliated to Jinan University during the period from September 2015 to March 2018. Clinical data such as fungal culture, clinical features, and serum(1,3)-β-D-glucan level were analyzed and compared between groups. Results Overall, 13 strains of Candida albicans and 18 strains of non-albicans Candida were isolated from the 31 patients with candidemia. The incidence of candidemia was associated with old age(>65 years), prior surgery(≤7 days), indwelling catheter(≥2 catheters and lasting ≥5 days), duration of mechanical ventilation(≥5 days)(P<0.05), but not associated with sex, underlying disease, prior use of anmicrobial and antifungal agents, immunosuppressant or glucocorticoid, or hypoproteinemia(P>0.05). Serum level of(1,3)-β-D-glucan was significantly higher in candidemia patients than in the patients with candida deep colonization and healthy controls(P<0.05). The sensitivity and specificity of(1,3)-β-D-glucan in diagnosing candidemia were 87.1% and 96.0%, respectively. The level of(1,3)-β-D-glucan was significantly higher in candidemia with bacterial infection than candidemia without bacterial infection(P<0.05). The level of of(1,3)-β-D-glucan was also significantly higher in the candidemia caused by Candida albicans alone than that caused by non-albicans Candida alone(P<0.05). Conclusions Non-albicans Candida is more prevalent than Candida albicans in candidiasis, but Candida albicans is still the most important Candida species. The incidence of candidemia is asociated with advanced age(>65 years), prior surgery within 7 days, indwelling catheters(≥2 catheters and lasting ≥5 days), and mechanical ventilation(≥5 days). Serum(1,3)-β-D-glucan level is valuable for early diagnosis of candidemia.
Objective To understand the etiology and clinical characteristics of candidemia, and the diagnostic value of(1,3)-β-Dglucan. Methods This analysis included 31 patients with candidemia, 39 patients with Candida deep colonization, and 50 healthy subjects, who were enrolled from Wuyi Chinese Hospital Affiliated to Jinan University during the period from September 2015 to March 2018. Clinical data such as fungal culture, clinical features, and serum(1,3)-β-D-glucan level were analyzed and compared between groups. Results Overall, 13 strains of Candida albicans and 18 strains of non-albicans Candida were isolated from the 31 patients with candidemia. The incidence of candidemia was associated with old age(>65 years), prior surgery(≤7 days), indwelling catheter(≥2 catheters and lasting ≥5 days), duration of mechanical ventilation(≥5 days)(P<0.05), but not associated with sex, underlying disease, prior use of anmicrobial and antifungal agents, immunosuppressant or glucocorticoid, or hypoproteinemia(P>0.05). Serum level of(1,3)-β-D-glucan was significantly higher in candidemia patients than in the patients with candida deep colonization and healthy controls(P<0.05). The sensitivity and specificity of(1,3)-β-D-glucan in diagnosing candidemia were 87.1% and 96.0%, respectively. The level of(1,3)-β-D-glucan was significantly higher in candidemia with bacterial infection than candidemia without bacterial infection(P<0.05). The level of of(1,3)-β-D-glucan was also significantly higher in the candidemia caused by Candida albicans alone than that caused by non-albicans Candida alone(P<0.05). Conclusions Non-albicans Candida is more prevalent than Candida albicans in candidiasis, but Candida albicans is still the most important Candida species. The incidence of candidemia is asociated with advanced age(>65 years), prior surgery within 7 days, indwelling catheters(≥2 catheters and lasting ≥5 days), and mechanical ventilation(≥5 days). Serum(1,3)-β-D-glucan level is valuable for early diagnosis of candidemia.
引文
[1] KULLBERG B J, ARENDRUP M C. Invasive candidiasis[J]. N Eng J Med, 2016, 374(8):794-795.
[2] KETT D H, AZOULAY E, ECHEVERRIA P M, et al. Candida bloodstream infections in intensive care units:analysis of the extended prevalence of infection in intensive care unit study[J].Crit Care Med, 2011, 39(4):665-670.
[3]林勇平,陈源,蒋月婷,等.(1,3)-β-D-葡聚糖在侵袭性真菌病诊断中的应用价值[J].临床检验杂志,2016, 34(2):124-125, 128.
[4]赖悦云,鲍立,卢锡京,等.普通血液病房恶性血液病患者念珠菌定植及侵袭性真菌感染的观察[J].中华医学杂志,2009,89(4):239-242.
[5]中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准和治疗原则(第四次修订版)[J].中华内科杂志,2013,52(8):704-709.
[6] NIETO M C, TELLERIA O, CISTERN A R, et al. Sentinel surveillance of invasive candidiasis in Spain:epidemiology and antifungal susceptibility[J]. Diagn Microbiol Infect Dis, 2015,81(1):34-40.
[7] WISPLINGHOFF H, EBBERS J, GEURTZ L, et al.Nosocomial bloodstream infectio-ns due to Candida spp. in the USA:species distribution, clinical features and antifungal susceptibilities[J]. Int J Antimicrob Agents, 2014, 43(1):78-81.
[8] YANG Z T,WU L,LIU X Y,et al. Epidemiology,species distribution and outco-me of nosocomial Candida spp.bloodstream infections in Shanghai[J]. BMC Infect Dis, 2014,14:241.
[9]王中新.叶乃芳,张博筠,等.92例医院获得性念珠菌血症患者临床特点及危险因素分析[J].中华传染病杂志,2016, 34(4):232-236.
[10] PFALLER M A,CASTANHEIRA M. Nosocomial candidiasis:antifungal stewardship and importance of rapid diagnosis[J].Med Mycol,2016, 54(1):1-22.
[11]陈玉,鲁俊锋,魏兵,等.82例念珠菌血症患者的临床分析[J].中华实验和临床感染病杂志(电子版),2017, 11(4):373-376.
[12]马春芳,陈倩倩,李芳秋,等.133例念珠菌血症临床与实验室分析[J].临床检验杂志,2013, 31(2):145-147.
[13] YOSHINO Y, WAKABAYASHI Y, SUZUKI S, et al. Clinical features of catheter-related candidemia at disease onset[J].Singapore Med J, 2014, 55(11):579-582.
[14] PAPPAS P G, KAUFFMAN C A, ANDES D R, et al. Clinical practice guideline for the management of candidiasis:2016update by the Infectious Diseases Society of America[J]. Clin Infect Dis,2016, 62(4):e1-50.
[15] KHATIB R,JOHNSON L B,FAKIH M G,et al. Current trends in candidemia and species distribution among adults:Candida glabrata surpasses C. albicans in diabetic patients and abdominal sources[J]. Mycoses, 2016, 59(12):781-786.
[16] TISSOT F, LAMOTH F, HAUSER P M, et al. Beta-glucan antigenemia anticipatesdiagnosis of blood culture negative intraabdominal candidiasis[J]. Am J Respir Crit Care Med, 2013,188(9):1100-1109.
[17]申旺,杨文丽,叶丽燕,等.血浆(1,3)-(3-D葡聚糖与侵袭性肺部真菌感染的关系[J].暨南大学学报(自然科学与医学版),2018,39(2):156-161.
[18] KARAGEORGOPOULOS D E, VOULOUMANOU E K,NTZIPRA F, et al.β-D-glucan assay for the diagnosis of invasive fungal infection:a meta analysis[J]. Clin Infect Dis,2011, 52(6):750-770.
[19] BANDARA H M,YAU J Y,WATT R M,et al. Pseudomonas aeruginosa inhibits in-vitro Candida biofilm development[J].BMC Microbiol,2010, 10:125.
[20] KIM S H, YOON Y K, KIM M J, et al. Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections[J]. Clin Microbiol Infect, 2013, 19(1):62-68.
[21]刘涌,孙永昌,卓婕,等.念珠菌血症合并细菌血流感染的临床与危险因素分析[J].中华结核和呼吸杂志,2014, 37(2):99-103.
[2] KETT D H, AZOULAY E, ECHEVERRIA P M, et al. Candida bloodstream infections in intensive care units:analysis of the extended prevalence of infection in intensive care unit study[J].Crit Care Med, 2011, 39(4):665-670.
[3]林勇平,陈源,蒋月婷,等.(1,3)-β-D-葡聚糖在侵袭性真菌病诊断中的应用价值[J].临床检验杂志,2016, 34(2):124-125, 128.
[4]赖悦云,鲍立,卢锡京,等.普通血液病房恶性血液病患者念珠菌定植及侵袭性真菌感染的观察[J].中华医学杂志,2009,89(4):239-242.
[5]中国侵袭性真菌感染工作组.血液病/恶性肿瘤患者侵袭性真菌病的诊断标准和治疗原则(第四次修订版)[J].中华内科杂志,2013,52(8):704-709.
[6] NIETO M C, TELLERIA O, CISTERN A R, et al. Sentinel surveillance of invasive candidiasis in Spain:epidemiology and antifungal susceptibility[J]. Diagn Microbiol Infect Dis, 2015,81(1):34-40.
[7] WISPLINGHOFF H, EBBERS J, GEURTZ L, et al.Nosocomial bloodstream infectio-ns due to Candida spp. in the USA:species distribution, clinical features and antifungal susceptibilities[J]. Int J Antimicrob Agents, 2014, 43(1):78-81.
[8] YANG Z T,WU L,LIU X Y,et al. Epidemiology,species distribution and outco-me of nosocomial Candida spp.bloodstream infections in Shanghai[J]. BMC Infect Dis, 2014,14:241.
[9]王中新.叶乃芳,张博筠,等.92例医院获得性念珠菌血症患者临床特点及危险因素分析[J].中华传染病杂志,2016, 34(4):232-236.
[10] PFALLER M A,CASTANHEIRA M. Nosocomial candidiasis:antifungal stewardship and importance of rapid diagnosis[J].Med Mycol,2016, 54(1):1-22.
[11]陈玉,鲁俊锋,魏兵,等.82例念珠菌血症患者的临床分析[J].中华实验和临床感染病杂志(电子版),2017, 11(4):373-376.
[12]马春芳,陈倩倩,李芳秋,等.133例念珠菌血症临床与实验室分析[J].临床检验杂志,2013, 31(2):145-147.
[13] YOSHINO Y, WAKABAYASHI Y, SUZUKI S, et al. Clinical features of catheter-related candidemia at disease onset[J].Singapore Med J, 2014, 55(11):579-582.
[14] PAPPAS P G, KAUFFMAN C A, ANDES D R, et al. Clinical practice guideline for the management of candidiasis:2016update by the Infectious Diseases Society of America[J]. Clin Infect Dis,2016, 62(4):e1-50.
[15] KHATIB R,JOHNSON L B,FAKIH M G,et al. Current trends in candidemia and species distribution among adults:Candida glabrata surpasses C. albicans in diabetic patients and abdominal sources[J]. Mycoses, 2016, 59(12):781-786.
[16] TISSOT F, LAMOTH F, HAUSER P M, et al. Beta-glucan antigenemia anticipatesdiagnosis of blood culture negative intraabdominal candidiasis[J]. Am J Respir Crit Care Med, 2013,188(9):1100-1109.
[17]申旺,杨文丽,叶丽燕,等.血浆(1,3)-(3-D葡聚糖与侵袭性肺部真菌感染的关系[J].暨南大学学报(自然科学与医学版),2018,39(2):156-161.
[18] KARAGEORGOPOULOS D E, VOULOUMANOU E K,NTZIPRA F, et al.β-D-glucan assay for the diagnosis of invasive fungal infection:a meta analysis[J]. Clin Infect Dis,2011, 52(6):750-770.
[19] BANDARA H M,YAU J Y,WATT R M,et al. Pseudomonas aeruginosa inhibits in-vitro Candida biofilm development[J].BMC Microbiol,2010, 10:125.
[20] KIM S H, YOON Y K, KIM M J, et al. Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections[J]. Clin Microbiol Infect, 2013, 19(1):62-68.
[21]刘涌,孙永昌,卓婕,等.念珠菌血症合并细菌血流感染的临床与危险因素分析[J].中华结核和呼吸杂志,2014, 37(2):99-103.