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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.

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.

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

【摘要】 目的 探討老年慢性阻塞性肺疾病(COPD)患者院內肺部真菌感染的可能易患因素、感染時間、臨床特征、感染常見真菌與預后。 方法 回顧性分析36例65歲以上COPD 院內肺部真菌感染患者與同期40例65歲以上COPD院內肺部非真菌感染患者的臨床資料。 結果 老年COPD患者院內肺部真菌感染的可能易患因素與長期使用廣譜抗生素、糖皮質激素,低蛋白血癥、粒細胞減少相關;吸煙時間較長及每年住院次數增多也是老年COPD患者發生院內肺部真菌感染的可能易感因素;約1/3患者肺部真菌發生在入院1~2周,臨床特征無特異性;病原菌主要為白色念珠菌(8055%),胸部X線表現以支氣管肺炎及團塊影改變為主,預后較差。 結論 老年COPD患者若長期使用廣譜抗生素和(或)糖皮質激素,有低蛋白血癥或粒細胞減少,可能會并發院內肺部真菌感染,預后較差,長期吸煙及多次住院患者也應提高警惕,重視可能易患因素并盡早采取預防與治療措施,減少死亡的發生。【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.

Low Dose MSCT Diagnosis of Pulmonary Fungal Infection

Objective To explore the diagnosis value of the low dose multi-slice spiral computed tomography (MSCT) imaging in pulmonary fungal infection in order to improve its diagnosis level. Methods CT manifestations of 106 cases of pulmonary fungal infection confirmed by operation, pathology, mycetes cultivation and follow-ups of clinical therapy were retrospectively analyzed. All cases underwent low dose MSCT examinations including CARE dose 4D and sinogram affirmed iterative reconstruction technology, and 6 cases underwent contrast-enhanced CT scanning. Results Among the basic MSCT findings of pulmonary fungal infection, they showed patch-nodular type in 54 cases, solid variant in 38 cases, and tumor type in 14 cases. In all cases, 91 cases displayed as mulifocality, 83 cases as polymorphism and 78 cases as polytropy. Among the 106 cases with comparative distinctive MSCT manifestations, bud of branch sign were showed in 39 cases, halo sign in 32 cases, wedge shape consolidation in 19 cases, ice needle sign in 15 cases, crescentic sign in 11 cases, air ring sign in 6 cases, and contra-halo sign in 4 cases. The nodules in the cavities were not enhanced in enhanced scan in 5 cases. Conclusions There are some distinctive MSCT findings in patients with pulmonary fungal infection. Pulmonary fungal infection can be diagnosed with typical MSCT findings in close combination with the clinical information.

經纖維支氣管鏡診斷曲霉感染100例分析

目的探討纖維支氣管鏡檢查在肺曲霉感染診斷中的作用。 方法回顧性分析2012年至2014年我院100例曲霉感染患者的臨床資料及纖維支氣管鏡(簡稱纖支鏡)檢查結果。 結果100例曲霉感染患者中, 男65例, 女35例, 年齡12~85歲, 30歲以下患者15例。62例合并基礎疾病, 包括20例結核, 23例腫瘤, 6例慢性阻塞性肺疾病。36例患者經纖支鏡病理檢查確診, 其中4例經纖支鏡肺活檢確診, 無并發癥發生; 64例患者纖支鏡灌洗液或痰液曲霉培養陽性, 屬于臨床診斷。 結論纖支鏡病理檢查及灌洗液培養是診斷肺曲霉感染的有效手段, 若臨床情況允許, 應盡早進行纖支鏡檢查明確診斷。

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

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.

1，3-β-D葡聚糖檢測對尿路插管所致真菌感染的診斷價值

【摘要】 目的 探討尿路插管所致真菌感染患者的血漿和尿液中1，3-β-D葡聚糖檢測的臨床意義。 方法 將2009年1-5月47例尿路插管所致真菌感染患者設為試驗組，50例正常健康體檢者設為對照組，分別檢測其血漿和尿液中1，3-β-D葡聚糖的水平。 結果 試驗組與對照組比較，血漿及尿液中1，3-β-D葡聚糖含量差異有統計學意義（Plt;0.001）；試驗組的尿液和血漿中1，3-β-D葡聚糖含量比較，有統計學意義（Plt;0.05），尿液中的1，3-β-D葡聚糖含量高于血漿。 結論 血漿和尿液1，3-β-D葡聚糖水平檢測可作為診斷泌尿系統真菌感染的可靠指標，且尿液樣本的診斷價值高于血漿。

Factors Associated with Fungal Infection Following Pancreatoduodenectomy

【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation． MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%， and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula， biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.

Clinical analysis of 47 cases of nosocomial pulmonary fungal infection in respiratory intensive care unit

Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.