Distribution of invasive fungal infections: Molecular epidemiology, etiology, clinical conditions, diagnosis and risk factors: A 3-year experience with 490 patients under intensive care
Distribution of invasive fungal infections: Molecular epidemiology, etiology, clinical conditions, diagnosis and risk factors: A 3-year experience with 490 patients under intensive care
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DOI：
10.1016/j.micpath.2020.104616
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发表时间：
2021-02-25
影响因子：
3.8
通讯作者：
Raiesi, Omid
中科院分区：
文献类型：
--
作者：
Boroujeni, Zeinab Borjian;Shamsaei, Sina;Raiesi, Omid
近年来，侵袭性真菌感染(IFIs)的发病率呈上升趋势。全球IFI的死亡率为10-49%。本研究旨在了解某三级卫生院侵袭性真菌感染的患病率、致病因素和危险因素，为医务人员有效预防、控制和治疗真菌感染提供有效的决策依据。目前的研究对1477名疑似系统性真菌感染的患者进行了调查，这些患者来自医院的不同单元。经常规真菌学检查筛查后，用互补的真菌学和分子生物学方法确诊。根据确诊的IFI诊断纳入患者，根据缺乏微生物学和组织学证实的IFI诊断排除患者。在这项研究中招募的1477名患者中，确诊的真菌感染病例为490例(169例确诊；321例可能)。在回收的真菌中，念珠菌出现频率最高的是念珠菌337种(68.8%)，其次是曲霉108种(22.1%)、接合菌21种(4.3%)、非念珠菌9种(1.8%)。真菌5株(1%)，真菌5株(1%)，镰刀菌4株(0.8%)，木霉属(0.2%)。恶性血液病和糖尿病是IFI确诊患者中最常见的基础疾病。这项研究观察到侵袭性念珠菌病与非白念珠菌和其他侵袭性腐生菌感染的频率增加。使用非白念珠菌制剂的侵袭性念珠菌病发病率的增加突出了侵袭性真菌感染的流行病学和治疗的新视角。
Recently, the prevalence of invasive fungal infections (IFIs) is rising. The global mortality rate of IFIs is 10-49%. This study aimed to determine the prevalence, the causative agents, and the risk factors associated with the invasive fungal infections in a tertiary health center to provide valid decision-grounds for healthcare professionals to effectively prevent, control, and treat fungal infections. The current study was conducted on 1477 patients suspected to have systemic fungal infections from different units of the hospital. After screening using routine mycological examination, the patients were confirmed with complementary mycological and molecular methods. Patients were included based on the confirmed diagnosis of IFI and excluded based on lack of a microbiologically and histologically proven diagnosis of IFI. Of the 1477 patients recruited in this study, confirmed cases of fungal infection were 490 (169 proven; 321 cases probable). Among the fungi recovered, Candida species had the highest frequency 337 (68.8%) followed by Aspergillus species 108 (22.1%), Zygomycetes species 21 (4.3%), non-Candida yeast 9 (1.8%). Others were black fungi 5 (1%), mycetoma agents 5 (1%), Fusarium 4 (0.8%), and Trichoderma (0.2%). Hematologic malignancies and diabetes mellitus were the most common underlying diseases among IFI-confirmed patients. This study observed an increased frequency of invasive candidiasis with non-albicans Candida and other invasive saprophytic fungal infections. The increased rate of invasive candidiasis with non-albicans agents highlights a new perspective in the epidemiology and treatment of invasive fungal infections.