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Risk Factors for Fungal Infection in Adult Recipients Following Living Donor Liver Transplantation

Objective To analyze the risk factors associated with fungal infections in adult recipients after living donor liver transplantation (LDLT). Methods Data of 189 recipients from January 2006 to December 2012 who received LDLT at our center were retrospectively analyzed. Cox regression analysis was used to analyze the risk factors for postoperative fungal infections. Results Postoperative fungal infection was found in 12 recipients. The most common infectious site was lung, whereas the most common fungal pathogen was Candida albicans. Multivariate analysis suggested preoperative low albumin level [HR=0.792, 95%CI (0.694, 0.903), P=0.001], massive intraoperative red blood cell transfusion [HR=4.322, 95%CI (1.308, 14.277), P=0.016] and longer postoperative intensive care unit (ICU) stay [HR=3.399, 95%CI (1.004, 11.506), P=0.049] were the independent risk factors for postoperative fungal infections. Conclusions Lung is the most common fungal infection site after LDLT. Preoperative low albumin level, massive intraoperative red blood cell transfusion and longer postoperative ICU contribute to fungal infections after LDLT.

Clinical Analysis of Elderly Patients with Chronic Obstructive Pulmonary Disease with Nosocomial Pulmonary Fungal Infection

【摘要】 目的 探讨老年慢性阻塞性肺疾病(COPD)患者院内肺部真菌感染的可能易患因素、感染时间、临床特征、感染常见真菌与预后。 方法 回顾性分析36例65岁以上COPD 院内肺部真菌感染患者与同期40例65岁以上COPD院内肺部非真菌感染患者的临床资料。 结果 老年COPD患者院内肺部真菌感染的可能易患因素与长期使用广谱抗生素、糖皮质激素,低蛋白血症、粒细胞减少相关;吸烟时间较长及每年住院次数增多也是老年COPD患者发生院内肺部真菌感染的可能易感因素;约1/3患者肺部真菌发生在入院1~2周,临床特征无特异性;病原菌主要为白色念珠菌(8055%),胸部X线表现以支气管肺炎及团块影改变为主,预后较差。 结论 老年COPD患者若长期使用广谱抗生素和(或)糖皮质激素,有低蛋白血症或粒细胞减少,可能会并发院内肺部真菌感染,预后较差,长期吸烟及多次住院患者也应提高警惕,重视可能易患因素并尽早采取预防与治疗措施,减少死亡的发生。【Abstract】 Objective To investigate the possible risk factors of nosocomial pulmonary fungal infection, infection time, the clinical features, common infection fungal and prognosis of elderly patients with chronic obstructive pulmonary disease (COPD). Methods The clinical data of 36 patient of COPD complicated with nosocomial pulmonary fungal infection over 65 years old and 40 patients without nosocomial pulmonary fungal infection were retrospectively analyzed. Results Longterm use of broadspectrum antibiotics and (or) glucocorticoid, hypoalbuminemia, neutropenia, smoking for a long time, and hospitalizations were risk factors for nosocomial pulmonary fungal infection in elderly COPD patients. In about 1/3 of patients, nosocomial pulmonary fungal infection occurred within one to two weeks of hospitalization. The clinical features were nonspecific. Pathogens were mainly Candida albicans (8055%). Bronchial pneumonia and group block were the main findings in Chest Xray. The prognosis was poor. Conclusion Elderly patients with COPD are prone to nosocomial pulmonary fungal infection if they have hypoproteinemia, neutropenia or use longterm broadspectrum antibiotics and (or) glucocorticoids.

The Interpretation of ATS Guideline of Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients in 2011

合并侵袭性肺部真菌感染的支气管中央性肉芽肿病一例

1，3-β-D葡聚糖检测对尿路插管所致真菌感染的诊断价值

【摘要】 目的 探讨尿路插管所致真菌感染患者的血浆和尿液中1，3-β-D葡聚糖检测的临床意义。 方法 将2009年1-5月47例尿路插管所致真菌感染患者设为试验组，50例正常健康体检者设为对照组，分别检测其血浆和尿液中1，3-β-D葡聚糖的水平。 结果 试验组与对照组比较，血浆及尿液中1，3-β-D葡聚糖含量差异有统计学意义（Plt;0.001）；试验组的尿液和血浆中1，3-β-D葡聚糖含量比较，有统计学意义（Plt;0.05），尿液中的1，3-β-D葡聚糖含量高于血浆。 结论 血浆和尿液1，3-β-D葡聚糖水平检测可作为诊断泌尿系统真菌感染的可靠指标，且尿液样本的诊断价值高于血浆。

Influence of De-escalation Antibacterial Therapy on Invasive Pulmonary Fungal Infection

Objective To investigate whether de-escalation antibacterial therapy would be helpful to antifungal treatment in patients with invasive pulmonary fungal infection( IPFI) .Methods A prospective study was conducted in 174 IPFI patients( male 106, female 68) in the Second Hospital of Hebei Medical University from January 2008 to July 2010. The clinical data was collected including symptoms, physical signs,microbiological results, treatment and prognosis, etc. The therapeutic results were compared between the patients who received or did not receive de-escalation antibacterial therapy. Results The predominant pathogenic fungus was Candida albicans, which accounted for 59. 7% of IPFI. The effect of antifungal therapy showed statistically significant difference between the patients who received de-escalation antibacterial therapy and the patients who did not ( 60. 0% vs. 34. 5% , P =0. 001) . Conclusion The deescalation use of antibacterial therapy would be helpful to antifungal efficacy.

类风湿关节炎合并毛霉菌肺部感染一例

A nomogram for predicting secondary pulmonary fungal infection in patients with acute exacerbations of chronic obstructive pulmonary disease

Objective To investigate the risk factors for secondary pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). And a visual tool using nomogram was developed and validated to assist in the clinical prediction of the probability of pulmonary fungal infection occurrence in AECOPD patients. Methods A retrospective cohort study method was used to collect AECOPD patients hospitalized in the Department of Respiratory, The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2021 as a training set. And AECOPD patients between January 2020 and December 2020 were collected as a validation set. Independent risk factors were determined through univariate, Lasso regression analyses. and multivariable logistic, A nomogram prediction model was constructed with these independent risk factors, and the nomogram was evaluated by receiver operating characteristic area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Results The use of glucocorticoid, combined use of antibiotics, duration of antibiotic use and hypoalbuminemia were independent risk factors for secondary pulmonary fungal infection in AECOPD patients (all P<0.05). The training set and validation set of the constructed prediction model had an AUC value of 0.915 [95%CI: 0.891 - 0.940] and 0.830 [95%CI: 0.790 - 0.871], respectively. The calibration curve showed that the predicted probability was in good agreement with the actual observed probability of pulmonary fungal infection in AECOPD patients. The corresponding decision curve analysis (DCA) indicated the nomogram had relatively ideal clinical utility. Conclusions The result showed that the use of glucocorticoid, combined use of antibiotics, prolonged antibiotic therapy and hypoalbuminemia was independent risk factors for pulmonary fungal infection in AECOPD patients. The clinical prediction model for secondary pulmonary fungal infection in AECOPD patients constructed in this study has strong predictive power and clinical practicability.

Evaluation on APACHEⅡ Score for Deep Fungal Infection in Patients with Severe Acute Pancreatitis at Admission

Objective　To evaluate the predicted value of APACHEⅡ score at admission for deep fungal infection（DFI） in patients with severe acute pancreatitis （SAP）.Methods　The clinical data of 132 patients with SAP from January 2006 to June 2011 in our hospital were analyzed retrospectively. The receiver operating characteristic curve （ROC） was used for evaluating the predicted value.Results　Thirty-nine patients with SAP infected DFI （29.5%）,of which 36 patients （92.3%） infected with Candida albicans,2 patients （5.1%） with Candida tropicalis,1 patient （2.6%） with pearl bacteria.And,among these 39 patients,27 patients （69.2%） infected at single site,12 patients （30.8%） infected at multi-site. The APACHEⅡ score in 39 patients with DFI was higher than that of 93 patients without DFI （17.1±3.8 versus 9.7±2.1, t=14.316,P=0.000）.The ROC for APACHEⅡ score predicting DFI was 0.745（P=0.000）, 95%CI was 0.641－0.849.When the cut off point was 15,it showed the best forecast performance,with specificity 0.81, sensitivity 0.72,Youden index 0.53. Conclusions　The APACHEⅡ score at admission can preferably predict DFI in patients with SAP； when the APACHEⅡ score is greater than 15,it prompts highly possible of DFI,so preventive anti-fungal treatment may be necessary.

Clinical Survey on Drug Use in Patients with Chronic Obstructive Pulmonary Disease Outside the Hospital

【摘要】　目的　总结慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD） 患者院外用药情况，并分析其院外用药情况、痰真菌检出率以及激素不良反应发生率的变化。　方法　调查2011年1-6月住院的161 例COPD 患者院外用药情况，将其分为遵医嘱使用糖皮质激素组（A组，包括口服和吸入激素）、使用非准字号药物组（B组）和未使用以上两种药物组（C组），对各组的痰真菌检出率进行统计学分析，并对A、B组激素不良反应的发生率进行分析。再将现阶段的调查结果与2006年同样研究结果进行比较。　结果　161例患者中使用口服糖皮质激素6例，使用吸入激素29例，使用非准字号药物32例，未使用以上两种药物94例。痰真菌检出率情况:B组检出率为62.5%，明显高于A组的17.14%、C组的27.66%；组间比较有统计学意义（Plt;0.001）。B组的药物不良反应发生率为37.5%；A组中口服激素发生率为50%，而使用吸入激素发生率为0%。与2006年同样研究结果比较，B组患者的比例明显下降，A组患者明显增多。　结论　使用非准字号药物的患者，真菌感染的危险性及激素不良反应的发生率较高，健康教育对于减少这些不良现象的发生发挥了重要作用。【Abstract】　Objective　To investigate the use of drugs in patients with chronic obstructive pulmonary disease (COPD) outside the hospital, and analyze the detection rate of fungus and the side effects of glucocorticosteroids (GCs), and their changes.　Methods　We investigated the drugs used outside the hospital in 161 patients with stable COPD between January and June 2011, who were divided into prescribed medication GCs group (group A, including oral GCs group and inhaled GCs group), drugs without authorization by SFDA (DWAS) group (group B) and other drugs group (group C). Then we made a statistical analysis on the detection rate of fungus, and the incidence rate of the side effects of GCs in the three groups. Finally we compared the present findings with the similar studies five years ago.　Results　Among the 161 patients, 6 took oral GCs, 29 used inhaled GCs, 32 used DWAS, and 94 used other drugs. The detection rate of fungus in group B was 62.5%, obviously higher than the other groups (17.14% in group A, and 27.66% in group B, Plt;0.05). The rate of side effects of GCs in group B was 37.5%, and 50% in oral GCs group, while no side effects of GCs was found in the inhaled GCs group. Compared with the similar study five years ago, the use of DWAS decreased, and the use of prescribed medication GCs among the patients increased significantly.　Conclusions　Patients taking DWAS have a high incidence rate of mycotic infection and side effects of GCs. Health education plays an important role in reducing the occurrences of these undesirable phenomena.