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Risk Factors of Invasive Fungal Infection in Respiratory Ward: A Retrospective Case Control Study

Objective To explore the risk factors of invasive fungal infection ( IFI) in respiratory ward. Methods A multi-center, retrospective, case-control study was carried out. Patients from five general hospitals in Chongqing city, diagnosed as fungal infection, or whose respiratory specimens were fungal positive, were retrospectively screened for IFI. Patients with respiratory infection and colonization of nonfungal cases in the same period of hospitalization were enrolled as control. Results Thirty-four patients diagnosed with IFI and 50 patients diagnosed with bacterial infection were analyzed for the risk factors of IFI. The demographic characteristics of patients including age and gender were not different( P gt; 0. 05) , but hospitalization days, carbapenem antibiotic use, chemotherapy, deep venous catheterization, total parenteralnutrition( TPN) , neutropenia, and renal disfunction were different significantly between the IFI group and the control group. Multiple logistic regression analysis showed that carbapenem antibiotic use ( OR = 6. 753) ,central venous catheterization ( OR = 5. 021) and TPN ( OR = 3. 199) were main risk factors of invasive fungal infection. Conclusion The carbapenem antibiotic use, central venous catheterization and TPN are risk factors for IFI in respiratory ward.

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.

Clinical and Etiology Research of Invasive Pulmonary Fungal Disease

Objective To summarize the clinical features, predisposing factors, diagnosis, therapeutic outcome, and prognosis of invasive pulmonary fungal infection( IPFI) . Methods 90 cases with pathologically proved IPFI, admitted in non-intensive care unit in Xiangya Hospital from January 2005 to February 2012, were retrospectively analyzed. Results The pathogenic examination revealed Aspergillosis in 56 cases( 62. 2% ) , Cryptococcus in 18 cases( 20. 0% ) , Mucormycosis in 6 cases( 6. 7% ) , and Histoplasma in 6 cases( 6. 7% ) , etc. The underlying diseases were reported in 87 cases, and mainly included COPD, pulmonary tuberculosis, and diabetes mellitus. Cough and expectoration were the common clinical symptoms. 49 patients ( 54. 4% ) received long-term and broad-spectrum antibiotic therapy. The CT results revealed masses type in 25 cases( 27. 8%) , nodule lesions type in 15 cases( 16. 7% ) , lung consolidation type in 22 cases( 24. 4% ) , cavity type in 22 cases( 24. 4% ) , aspergilloma type in 6 cases( 6. 7% ) . 47 patients were clinical diagnosed with IPFI before biopsy with preliminary diagnosis accordance rate of 52. 2% . 31 cases ( 34. 4% ) underwent surgical resection of pulmonary lesions, and no recurrence was detected over two-year follow up. 56 cases ( 62. 2% ) received systemic anti-fugal therapy, and 43 cases( 76. 8% ) were cured or significantly improved. 3 cases ( 3. 3% ) refused any therapy. Conclusions The most frequently isolated pathogen of IPFI is Aspergillosis. The mainly underlying diseases are COPD, pulmonary tuberculosis, and diabetes mellitus. Long-termand broad-spectrum antibiotic therapy may be the major risk factor. Pathological examination is needed for final diagnosis. Surgical procedure can achieve optimal prognosis.

In vitro Antifungal Spectrum and Activity of 1% Naftifine-0.25% Ketoconazole Cream Compared with 2% Ketoconazole Cream and 1% Terbinafine Cream

Objective　To research the anti-fungal spectrum and activity of the cream containing 1% naftifine-0.25% ketoconazole compared with other two creams that contain of 2% ketoconazole and of 1% terbinafine, respectively. Methods　The agar diffusion method was used to judge drug sensitivity. Twenty-nine isolates of pathogenic fungi belonging to 11 species from clinic and three species of Malassezia standard stains were enrolled into the experiment. Organism suspension of each species was spread on the surface of the plate of the optimal media containing 2% agar. Then wells were made in the plate and three types of cream were put in each well respectively. After seven-day incubation, the diameter of the inhibition zone around the well full of each cream was observed and recorded. Results　The inhibition zone around the well full of 1% naftifine-0.25% ketoconazole cream for all experiment isolates (Dermatophytes, Candida spp., Sporothrix schenkii, Fonsecaea pedrosoi, Fusarium graminearum, Malassezia furfur, M. globosa and M. sympodialis) was observed, with the mean diameter of 45.46mm. Similarly, the mean diameter of inhibition zone of 2% ketoconazole cream for all experiment isolates was 23.92mm. About 1% terbinafine cream, the mean diameter was 29.81mm but there was no inhibition zone observed around Candida krusei and Candida albicans mycelial-form. There were significant significances for mean diameters of the inhibition zone when comparing 1% naftifine-0.25% ketoconazole cream with 2% ketoconazole cream (P=0.000) and with 1% terbinafine cream (P=0.000). Conclusion　The anti-fungal spectrum of 1% naftifine-0.25% ketoconazole cream is wider than that of 1% terbinafine cream. The antifungal activity of 1% naftifine-0.25% ketoconazole cream is ber than that of 2% ketoconazole cream and 1% terbinafine cream.

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.

Clinical Research on Correlation Factors of Concurrent Fungal Infections in Old Patients with Pulmonary Diseases: 49 Case Reports

摘要:目的: 探讨我院呼吸内科病房老年肺部疾病患者并发真菌感染发病的相关因素,分析其易患因素、临床特征和治疗。 方法 : 采用回顾性调查方法对2002年1月至2008年6月收住内科的经微生物检查证实49例继发真菌感染的患者进行分析,并与同期无真菌感染的肺部疾病患者(对照组)比较。 结果 : 在呼吸内科病房中,老年患者院内肺部真菌感染发生率为378%,主要感染部位为泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是继发院内肺部真菌感染最常见的基础疾病,其感染因素为长期使用广谱抗生素(962%)和糖皮质激素(332%)、营养状况不良(583%)出现低蛋白血症及合并糖尿病、白细胞减少和侵袭性诊疗操作等。肺部真菌感染的临床表现无特异性,确诊需结合痰培养,组织病理学和临床表现来确定,感染菌种以白色念珠菌为主,占626%。氟康唑治疗有效率914%。研究组与同期无真菌感染的肺部疾病患者(对照组)比较:病死率分别为612%和082%,两组治疗无效的病例(恶化和死亡病例)比较差异有显著性。 结论 : 院内真菌是呼吸系统疾病继发感染的重要病原体,而白色假丝酵母菌是院内肺部真菌感染的主要致病菌,宿主免疫状态、感染播散和疾病严重程度是影响预后的因素。该研究认为老年肺部疾病患者并发真菌感染的相关因素和影响预后的因素对其预防、诊断、治疗、改进预后和生存质量有重要的临床意义。除有效的抗真菌治疗外,积极的综合治疗有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.

Research Progress of Feasibility of Dendritic Cell Antifungal Vaccines

Fungal infection is an important clinical problem for patients with immune deficiency or immunosuppression. With deadly fungus infection case increasing, the development of antifungal vaccine attracts the attention of researchers. Dendritic cell (DC) is the unique antigen presenting cell (APC) to trigger the antifungal immune reaction, and recent studies indicate that the targeted vaccination strategy based on DC have prospective antifungal potentials. In this paper, we review the antifungal immunity mechanism and recent development of the targeted DC antifungal strategy.

The Interpretation of the ECL-3 Guideline

The Interpretation of Diagnosis and Treatment Guideline of Invasive Fungal Disease in Patients with Hematological Diseases

The Interpretation of Guidelines for the Management of Candidiasis from Infectious Diseases Society of America 2009