传染病诊治实验室侵袭性真菌感染流行趋势与特征.ppt

CID　2017， DOI: 10.1093/cid/ciw691 CID　2017， DOI: 10.1093/cid/ciw691 WGS analysis genetic relationship 念珠菌耐药机制 念珠菌对唑类药物耐药的危险因素 原发性耐药菌株感染 唑类药物使用 抗厌氧菌药物 肿瘤患者、粒细胞减少 CVC 继发耐药发生 粒细胞减少 慢性肾功能衰竭 器官移植 之前用唑类药物3ds 病区念珠菌对氟康唑耐药15% Mycoses, 2016, 59, 198–219 IFI流行状况 侵袭性念珠菌病流行特点 侵袭性曲霉病流行特点 侵袭性真菌感染流行趋势和特征 Invasive aspergillosis (IA) IA is among the most serious IFIs in immuno-compromised hosts Data from China patients are generally limited Classical risk factors include Underlying disease of the host Co-morbidities Medications Environment or nosocomial risk exposure, and Neutropenia, chemotherapy, and corticosteroid therapy were main risk factors in a retrospective, single-centre study in Thailand (2000–2005) Kiertiburanakul S, et al. J Med Assoc Thai 2007;90:895–902 Baddley JW. Med Mycol 2011;49(S1):S7–S12 IA的临床类别 Critical Care201519:7 DOI: 10.1186/s13054-014-0722-7 儿童IA基础疾病 Ann Intensive Care. 2012; 2: 6. 儿童IA菌种构成 Ann Intensive Care. 2012; 2: 6. Chronic obstructive pulmonary disease (COPD) and IA Patients with COPD are an emerging group at risk for IA Analysis of Chinese COPD patients with and without invasive pulmonary aspergillosis (IPA)* Independent risk factors associated with IPA in COPD patients included Systemic use of steroids in the stable phase Treatment with ≥3 antibiotics during hospitalisation Antibiotic treatment 10 days Baddley JW. Med Mycol 2011;49(S1):S7–S12 Xu H et al. Clin Microbiol Infect 2012;18:403–8 COPD + IPA (n=30) COPD alone (n=60) P value Mechanical ventilation (%) 43.3 5 0.001 Hospital stay (d) 45.8 ± 39.1 18.4 ± 11.8 0.001 Mortality (%) 43.3 11.4 0.001 * Retrospective single-centre analysis in Guangzhou, China Epidemiology of Aspergillosis in Mainland China from 1991-2009 By literature review from 1991-2009; Diagnosed majorly by microscopically morphology and culture; 1447 cases were included, 481 with microbiological evidence; 153 A. fumigatus identified; 1047 being pulmonary infections; Non-fumigatus increasing; Chin J Mycol 2010,5(4):24