Emerging invasive zygomycosis in a tertiary care center: epidemiology and associated risk factors
Emerging invasive zygomycosis in a tertiary care center: epidemiology and associated risk factors
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DOI：
10.1016/j.ijid.2009.11.024
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发表时间：
2010-09-01
影响因子：
8.4
通讯作者：
Garbino, Jorge
中科院分区：
文献类型：
--
作者：
Ambrosioni, Juan;Bouchuiguir-Wafa, Kalthum;Garbino, Jorge
目的：侵袭性接合菌病是一种罕见的真菌性机会性疾病，发病率和死亡率高，主要影响免疫抑制患者。本文介绍的是我们对过去五年来瑞士日内瓦大学医院与该病发病率增加相关的流行病学因素的调查。方法：回顾性分析接合菌培养阳性患者的临床图表和微生物学记录，评价其易感因素和流行病学特征。结果：1989-2003年确诊/疑似侵袭性感染19例，其中3例确诊，2003-2008年确诊16例。虽然接合菌阳性分离株的数量基本保持稳定，但自2003年在我院引入伏立康唑和卡泊芬金后，侵袭性感染和定植患者的比例增加（p < 0.001）。所有病例均无关联，未发现医院接触源或季节性聚集。病例的增加与伏立康唑和卡泊芬净使用的增加以及免疫抑制患者数量的增加一致，特别是同种异体骨髓移植接受者。结论：侵袭性接合菌病是一种新出现的感染，可能与免疫抑制患者的增加和新型抗真菌药物的广泛使用有关。改变抗真菌药物预防和治疗处方可能有助于控制这种出现。(C) 2010年国际传染病学会。Elsevier Ltd.出版。版权所有。
Objectives: Invasive zygomycosis is a rare fungal opportunistic disease with a high morbidity and mortality rate, predominantly affecting immunosuppressed patients. Presented herein is our investigation of the epidemiological factors associated with an increasing incidence of the disease at the University of Geneva Hospitals, Geneva, Switzerland, over the past five years.Methods: This was a retrospective study of the clinical charts and microbiology records of patients with a positive culture for zygomycetes, to evaluate predisposing factors and epidemiological characteristics.Results: Three of 19 proven/probable invasive infections were diagnosed during 1989-2003, and 16 during 2003-2008. While the number of positive isolates for zygomycetes remained mainly stable, the ratio between invasive infections and colonized patients increased after the introduction of voriconazole and caspofungin in 2003 at our institution (p < 0.001). All cases were unrelated and no nosocomial source of exposure or seasonal aggregation was identified. The increase in cases was coincident with an incremented use of voriconazole and caspofungin, and with an increased number of immunosuppressed patients, especially allogeneic bone marrow transplant recipients.Conclusions: Invasive zygomycosis is an emerging infection at our center and is probably related to an increase in immunosuppressed patients and the wide use of newer antifungals. Changes in antifungal drug prophylaxis and treatment prescription may help to control this emergence. (C) 2010 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.