老年人深部念珠菌感染诊断与治疗进展
摘要
<正>随着社会老龄化的加速,由于老年人生理防御机能、机体免疫功能的下降,各种慢性疾病在老年人中常见,而广谱抗菌药物、激素类药物、抗肿瘤类药物、免疫抑制剂等在临床上大量或不合理的长期使用,放化疗、介入治疗的发展以及留置各种动静脉导管、机械辅助通气等医疗措施在临床上的广泛应用,老年病人院内真菌感染发病率明显增加~([1-7])。Wisplinghoff等~([8])对美国49家医院8年间的24179例医院血液感染病原菌检测发现,念珠菌是第4位最常见的血液感染病原菌。由于念珠菌感染病人发病的症状、体征及影像学检查并无特异性,而且真菌感染多为条件致病,标本分离出
引文
[1]Chapman B,Slavin M,Marriott D,et al.Changing epidemiology of candidaemia in Australia[J].J Antimicrob Chemother,2017,72(4):1103-1108.
[2]Arendrup MC.Candida and candidaemia:susceptibility and epidemiology[J].Dan Med J,2013,60(11):B4698.
[3]Kullberg BJ,Arendrup MC.Invasive Candidiasis[J].NEngl J Med,2015,373(15):1445-1456.
[4]Gamaletsou MN,Walsh TJ,Zaoutis T,et al.A prospective,cohort,multicentre study of candidaemia in hospitalized adult patients with haematological malignancies[J].Clin Microbiol Infect,2014,20(1):50-57.
[5]Chakrabarti A,Sood P,Rudramurthy SM,et al.Incidence,characteristics and outcome of ICU-acquired candidemia in India[J].Intensiv Care Med,2014,41(2):285-295.
[6]Chen PY,Chuang YC,Wang JT,et al.Comparison of epidemiology and treatment outcome of patients with candidemia at a teaching hospital in Northern Taiwan,in 2002 and 2010[J].J Microbiol Immunol Infect,2014,47(2):95-103.
[7]Fridkin SK,Jarvis WR.Epidemiology of nosocomial fungal infections[J].Clin Microbiol Rev,1996,9(4):499-511.
[8]Wisplinghoff H,Bischoff T,Tallent SM,et al.No so comial Bloodstream Infections in US Hospitals:Analysis of 24,179Cases from a Prospective Nationwide Surveillance Study[J].Clin Infect Dis,2004,39(3):309-317.
[9]Pfaller MA,Diekema DJ,Jones RN,et al.International Surveillance of Bloodstream Infections Due to Candida Species:Frequency of Occurrence and In Vitro Susceptibilities to Fluconazole,Ravuconazole,and Voriconazole of Isolates Collected from 1997 through 1999 in the SENTRY Antimicrobial Surveillance Program[J].J Clin Microbiol,2001,39(9):3254-3259.
[10]Xiao M,Sun ZY,Kang M,et al.Five-year National Surveillance of Invasive Candidiasis:Species Distribution and Azole Susceptibility from the China Hospital Invasive Fungal Surveillance Net(CHIF-NET)Study[J].J Clin Microbiol,2018,56(7):e00577-18.
[11]Pfaller MA,Messer SA,Woosley LN,et al.Echinocandin and triazole antifungal susceptibility profiles for clinical opportunistic yeast and mold isolates collected from 2010 to2011:application of new CLSI clinical breakpoints and epidemiological cutoff values for characterization of geographic and temporal trends of antifungal resistance.[J].J Clin Microbiol,2013,51(8):2571-2581.
[12]Pfaller MA,Rhomberg PR,Messer SA,et al.Isavuconazole,micafungin,and 8 comparator antifungal agents'susceptibility profiles for common and uncommon opportunistic fungi collected in 2013:temporal analysis of antifungal drug resistance using CLSI species-specific clinical breakpoints and proposed epidemiological cutoff values[J].Diagn Microbiol Infect Dis,2015,82(4):303-313.
[13]Pfaller MA,Messer SA,Jones RN,et al.Antifungal susceptibilities of Candida,Cryptococcus neoformans and Aspergillus fumiga-tus from the Asia and Western Pacific region:data from the SENTRY antifungal surveillance program(2010-2012)[J].J Antibiot(Tokyo),2015,68(9):556-561.
[14]Xiao M,Fan X,Chen SC,et al.Antifungal susceptibilities of Candida glabrata species complex,Candida krusei,Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China:3 year national surveillance[J].J Antimicrob Chemother,2015,70(3):802-810.
[15]Pappas PG,Kauffman CA,Andes DR,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):409-417.
[16]王立万.老年人深部真菌感染的诊断与治疗进展[J].中国药物应用与监测,2006,3(4):31-36.
[17]缪竞智.老年人肺部真菌感染的诊断与治疗[J].中华老年医学杂志,2005,24(5):329-331.
[18]中华医学会“念珠菌病诊治策略高峰论坛”专家组.念珠菌病诊断与治疗:专家共识[J].中国感染与化疗杂志,2011,11(2):81-95.
[19]Mandell GL,Bennett JE,Dolin R.Principles and Practice of Infectious Diseases[M].7th ed.Philadelphia:Churchill Livingstone,2010:3225-3240.
[20]Kan LW,Lin JD.Management of systemic candidal infections in the intensive care unit[J].Am J Health Syst Pharm,2002,59(1):33-41.
[21]Pappas PG,Kauffman CA,Andes D,et al.Clinical practice guidelines for the management of candidiasis:2009 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,48(5):503-535.
[22]Goldman M,Cloud GA,Wade KD,et al.A randomized study of the use of flu-conazole in continuous versus episodic therapy in patients with advanced HIV infection and a history of oropharyngeal candidiasis:AIDS Clinical Trials Group Study 323/Mycoses Study Group Study 40[J].Clin Infect Dis,2005,41(10):1473-1480.
[23]Barchiesi F,Orsetti E,Gesuita R,et al.Epidemiology,clinical characteristics,and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014[J].Infection,2016,44(2):205-213.
[24]Bassetti M,Merelli M,Ansaldi F,et al.Clinical and therapeutic aspects of candidemia:A five year single centre study[J].PLoS One,2015,10(5):e127534.
[25]Ng K,Schorr C,Reboli AC,et al.Incidence and mortality of sepsis,severe sepsis,and septic shock in intensive care unit patients with candidemia[J].Infect Dis(Lond),2015,47(8):584-587.
[2]Arendrup MC.Candida and candidaemia:susceptibility and epidemiology[J].Dan Med J,2013,60(11):B4698.
[3]Kullberg BJ,Arendrup MC.Invasive Candidiasis[J].NEngl J Med,2015,373(15):1445-1456.
[4]Gamaletsou MN,Walsh TJ,Zaoutis T,et al.A prospective,cohort,multicentre study of candidaemia in hospitalized adult patients with haematological malignancies[J].Clin Microbiol Infect,2014,20(1):50-57.
[5]Chakrabarti A,Sood P,Rudramurthy SM,et al.Incidence,characteristics and outcome of ICU-acquired candidemia in India[J].Intensiv Care Med,2014,41(2):285-295.
[6]Chen PY,Chuang YC,Wang JT,et al.Comparison of epidemiology and treatment outcome of patients with candidemia at a teaching hospital in Northern Taiwan,in 2002 and 2010[J].J Microbiol Immunol Infect,2014,47(2):95-103.
[7]Fridkin SK,Jarvis WR.Epidemiology of nosocomial fungal infections[J].Clin Microbiol Rev,1996,9(4):499-511.
[8]Wisplinghoff H,Bischoff T,Tallent SM,et al.No so comial Bloodstream Infections in US Hospitals:Analysis of 24,179Cases from a Prospective Nationwide Surveillance Study[J].Clin Infect Dis,2004,39(3):309-317.
[9]Pfaller MA,Diekema DJ,Jones RN,et al.International Surveillance of Bloodstream Infections Due to Candida Species:Frequency of Occurrence and In Vitro Susceptibilities to Fluconazole,Ravuconazole,and Voriconazole of Isolates Collected from 1997 through 1999 in the SENTRY Antimicrobial Surveillance Program[J].J Clin Microbiol,2001,39(9):3254-3259.
[10]Xiao M,Sun ZY,Kang M,et al.Five-year National Surveillance of Invasive Candidiasis:Species Distribution and Azole Susceptibility from the China Hospital Invasive Fungal Surveillance Net(CHIF-NET)Study[J].J Clin Microbiol,2018,56(7):e00577-18.
[11]Pfaller MA,Messer SA,Woosley LN,et al.Echinocandin and triazole antifungal susceptibility profiles for clinical opportunistic yeast and mold isolates collected from 2010 to2011:application of new CLSI clinical breakpoints and epidemiological cutoff values for characterization of geographic and temporal trends of antifungal resistance.[J].J Clin Microbiol,2013,51(8):2571-2581.
[12]Pfaller MA,Rhomberg PR,Messer SA,et al.Isavuconazole,micafungin,and 8 comparator antifungal agents'susceptibility profiles for common and uncommon opportunistic fungi collected in 2013:temporal analysis of antifungal drug resistance using CLSI species-specific clinical breakpoints and proposed epidemiological cutoff values[J].Diagn Microbiol Infect Dis,2015,82(4):303-313.
[13]Pfaller MA,Messer SA,Jones RN,et al.Antifungal susceptibilities of Candida,Cryptococcus neoformans and Aspergillus fumiga-tus from the Asia and Western Pacific region:data from the SENTRY antifungal surveillance program(2010-2012)[J].J Antibiot(Tokyo),2015,68(9):556-561.
[14]Xiao M,Fan X,Chen SC,et al.Antifungal susceptibilities of Candida glabrata species complex,Candida krusei,Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China:3 year national surveillance[J].J Antimicrob Chemother,2015,70(3):802-810.
[15]Pappas PG,Kauffman CA,Andes DR,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):409-417.
[16]王立万.老年人深部真菌感染的诊断与治疗进展[J].中国药物应用与监测,2006,3(4):31-36.
[17]缪竞智.老年人肺部真菌感染的诊断与治疗[J].中华老年医学杂志,2005,24(5):329-331.
[18]中华医学会“念珠菌病诊治策略高峰论坛”专家组.念珠菌病诊断与治疗:专家共识[J].中国感染与化疗杂志,2011,11(2):81-95.
[19]Mandell GL,Bennett JE,Dolin R.Principles and Practice of Infectious Diseases[M].7th ed.Philadelphia:Churchill Livingstone,2010:3225-3240.
[20]Kan LW,Lin JD.Management of systemic candidal infections in the intensive care unit[J].Am J Health Syst Pharm,2002,59(1):33-41.
[21]Pappas PG,Kauffman CA,Andes D,et al.Clinical practice guidelines for the management of candidiasis:2009 update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,48(5):503-535.
[22]Goldman M,Cloud GA,Wade KD,et al.A randomized study of the use of flu-conazole in continuous versus episodic therapy in patients with advanced HIV infection and a history of oropharyngeal candidiasis:AIDS Clinical Trials Group Study 323/Mycoses Study Group Study 40[J].Clin Infect Dis,2005,41(10):1473-1480.
[23]Barchiesi F,Orsetti E,Gesuita R,et al.Epidemiology,clinical characteristics,and outcome of candidemia in a tertiary referral center in Italy from 2010 to 2014[J].Infection,2016,44(2):205-213.
[24]Bassetti M,Merelli M,Ansaldi F,et al.Clinical and therapeutic aspects of candidemia:A five year single centre study[J].PLoS One,2015,10(5):e127534.
[25]Ng K,Schorr C,Reboli AC,et al.Incidence and mortality of sepsis,severe sepsis,and septic shock in intensive care unit patients with candidemia[J].Infect Dis(Lond),2015,47(8):584-587.