• 四川大學(xué)華西醫(yī)院感染性疾病中心（成都，610041）;

【摘要】　目的　 對季也蒙念珠菌感染患者的臨床及微生物學(xué)特征進(jìn)行分析，為臨床診治提供參考。　方法　 收集2006年1月-2008年12月病原菌培養(yǎng)為季也蒙念珠菌的10例住院患者資料進(jìn)行回顧性分析。　結(jié)果　 季也蒙念珠菌感染患者存在多種基礎(chǔ)疾病，大多數(shù)患者（8/10）有易感因素，其中7例使用廣譜抗菌藥物。10例中有8例為深部真菌感染。其臨床表現(xiàn)與感染部位有關(guān)，主要累及泌尿道、呼吸道和皮膚軟組織。多數(shù)深部感染患者（6/8）在感染前存在同部位細(xì)菌感染，部分患者（3/8）在相同部位還可分離出其他真菌。全部季也蒙念珠菌菌株對兩性霉素B敏感，大多數(shù)菌株（9/10）對氟康唑敏感。僅1例患者因肺部感染、呼吸衰竭死亡，其余患者經(jīng)氟康唑、伊曲康唑或特比萘芬等抗真菌藥物治愈。　結(jié)論　 季也蒙念珠菌感染多發(fā)生于有基礎(chǔ)疾病、存在真菌易感因素者，感染部位多為原細(xì)菌感染部位，常合并其他細(xì)菌或真菌感染。部分菌株對氟康唑和伊曲康唑中敏或耐藥，治療應(yīng)根據(jù)藥敏進(jìn)行選擇。
【Abstract】　Objective　 To analyze the clinical and microbiologic characters of candida guilliermondii to improve the clinical diagnosis and treatment.　Methods　 The clinical data of 10 patients with candida guilliermondii infection diagnosed in our hospital from January 2006 to December 2008 were retrospectively analyzed.　Results　 All the patients had several underlying conditions; eight patients had predisposing factors and seven patients were prescribed with broad-spectrum antibacterials. Eight patients had deep mycoses, whose clinical manifestation was associated with the infectious sites, mainly involved in urinary tract, respiratory tract and skin-soft tissues. Most deep mycoses (6/8) had prior bacterial infection at the candida guilliermondii infection site; some patients (3/8) had other fungous infection at the same time. All the strains were sensitive to amphotericin B; most fungous strains (9/10) were sensitive to fluconazole. One patient died of pulmonary infection and respiratory failure, and the others were cured by fluconazole, itraconazole or terbinafine.　Conclusion　 Candida guilliermondii infection mainly occurs in patients with underlying conditions and predisposing factors. The infectious sites have prior bacterial infection and bacterial infection or fungous infection at the same time. Since some candida guilliermondii strains were not sensitive to fluconazole and itraconzole, drug sensitive test should be consulted.

引用本文： 馬元吉,葉慧,劉凱,呂曉菊. 季也蒙念珠菌感染臨床分析. 華西醫(yī)學(xué), 2011, 26(1): 34-37. doi: 復(fù)制

1. 　Maschmeyer G. The changing epidemiology of invasive fungal infections: new threats[J]. Int J Antimicrob Agents, 2006, 27 (Suppl 1): 3-6.
2. 　Chakrabarti A, Chatterjee SS, Rao KL, et al. Recent experience with fungaemia: change in species distribution and azole resistance[J]. Scand J Infect Dis, 2009, 41(4): 275-284.
3. 　Almirante B, Rodriguez D, Park BJ, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003[J]. J Clin Microbiol, 2005, 43(4): 1829-1835.
4. 　Castagnola E, Machetti M, Bucci B, et al. Antifungal prophylaxis with azole derivatives[J]. Clin Microbiol Infect, 2004, 10 (Suppl 1): 86-95.
5. 　劉正印, 李旭麗, 王愛霞. 院內(nèi)真菌感染149例分析[J]. 中華醫(yī)學(xué)雜志, 2003, 83(5): 50-53.
6. 　Krcmery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance[J]. J Hosp Infect, 2002, 50(4): 243-260.
7. 　Pfaller MA, Diekema DJ, Gibbs DL, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10. 5-year analysis of susceptibilities of Candida Species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion[J]. J Clin Microbiol, 2010, 48(4): 1366-1377.
8. 　Diekema DJ, Messer SA, Boyken LB, et al. In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods[J]. J Clin Microbiol, 2009, 47(10): 3170-3177.
9. 　韓旭東, 黃慮. 深部真菌感染的臨床和實(shí)驗(yàn)室診斷方案[J]. 上海醫(yī)藥, 2004, (10): 441-443.
10. 　周庭銀. 臨床微生物學(xué)診斷與圖解[M]. 2版. 上海: 上?？茖W(xué)技術(shù)出版社, 2007: 318-319.
11. 　Medeiros EA, Lott TJ, Colombo AL, et al. Evidence for a pseudo-outbreak of Candida guilliermondii fungemia in a university hospital in Brazil[J]. J Clin Microbiol, 2007, 45(3): 942-947.
12. 　Girmenia C, Pizzarelli G, Cristini F, et al. Candida guilliermondii fungemia in patients with hematologic malignancies[J]. J Clin Microbiol, 2006, 44(7): 2458-2464.
13. 　Peman J, Bosch M, Canton E, et al. Fungemia due to Candida guilliermondii in a pediatric and adult population during a 12-year period[J]. Diagn Microbiol Infect Dis, 2008, 60(1): 109-112.
14. 　Miranda LN, van der Heijden IM, Costa SF, et al. Candida colonisation as a source for candidaemia[J]. J Hosp Infect, 2009, 72(1): 9-16.
15. 　Pfaller MA, Diekema DJ. Rare and emerging opportunistic fungal pathogens: concern for resistance beyond Candida albicans and Aspergillus fumigatus[J]. J Clin Microbiol, 2004, 42(10): 4419-4431.
16. 　Pfaller MA, Diekema DJ, Mendez M, et al. Candida guilliermondii, an opportunistic fungal pathogen with decreased susceptibility to fluconazole: geographic and temporal trends from the ARTEMIS DISK antifungal surveillance program[J]. J Clin Microbiol, 2006, 44(10): 3551-3556.
17. 　Barchiesi F, Spreghini E, Tomassetti S, et al. Effects of caspofungin against Candida guilliermondii and Candida parapsilosis[J]. Antimicrob Agents Chemother, 2006, 50(8): 2719-2727.
18. 　Canton E, Peman J, Sastre M, et al. Killing kinetics of caspofungin, micafungin, and amphotericin B against Candida guilliermondii[J]. Antimicrob Agents Chemother, 2006, 50(8): 2829-2832.
19. 　Pfaller MA, Boyken L, Hollis RJ, et al. In vitro susceptibility of invasive isolates of Candida spp. to anidulafungin, caspofungin, and micafungin: six years of global surveillance[J]. J Clin Microbiol, 2008, 46(1): 150-156.
20. 　Savini V, Catavitello C, Di MI, et al. Pan-azole-resistant Candida guilliermondii from a leukemia patient’s silent funguria[J]. Mycopathologia, 2010, 169(6): 457-459.
21. 　Pfaller MA, Boyken L, Hollis RJ, et al. In vitro activities of anidulafungin against more than 2, 500 clinical isolates of Candida spp. , including 315 isolates resistant to fluconazole[J]. J Clin Microbiol, 2005, 43(11): 5425-5427.
22. 　Ostrosky-Zeichner L, Rex JH, Pappas PG, et al. Antifungal susceptibility survey of 2000 bloodstream Candida isolates in the United States[J]. Antimicrob Agents Chemother, 2003, 47(10): 3149-3154.
23. 　Kabbara N, Lacroix C, de Latour RP, et al. Breakthrough C, parapsilosis and C. Guilliermondii blood stream infections in allogeneic hematopoietic stem cell transplant recipients receiving long-term caspofungin therapy[J]. Haematologica, 2008, 93(4): 639-640.
  1. 1. 　Maschmeyer G. The changing epidemiology of invasive fungal infections: new threats[J]. Int J Antimicrob Agents, 2006, 27 (Suppl 1): 3-6.
  2. 2. 　Chakrabarti A, Chatterjee SS, Rao KL, et al. Recent experience with fungaemia: change in species distribution and azole resistance[J]. Scand J Infect Dis, 2009, 41(4): 275-284.
  3. 3. 　Almirante B, Rodriguez D, Park BJ, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infection: results from population-based surveillance, barcelona, Spain, from 2002 to 2003[J]. J Clin Microbiol, 2005, 43(4): 1829-1835.
  4. 4. 　Castagnola E, Machetti M, Bucci B, et al. Antifungal prophylaxis with azole derivatives[J]. Clin Microbiol Infect, 2004, 10 (Suppl 1): 86-95.
  5. 5. 　劉正印, 李旭麗, 王愛霞. 院內(nèi)真菌感染149例分析[J]. 中華醫(yī)學(xué)雜志, 2003, 83(5): 50-53.
  6. 6. 　Krcmery V, Barnes AJ. Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance[J]. J Hosp Infect, 2002, 50(4): 243-260.
  7. 7. 　Pfaller MA, Diekema DJ, Gibbs DL, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: a 10. 5-year analysis of susceptibilities of Candida Species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion[J]. J Clin Microbiol, 2010, 48(4): 1366-1377.
  8. 8. 　Diekema DJ, Messer SA, Boyken LB, et al. In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods[J]. J Clin Microbiol, 2009, 47(10): 3170-3177.
  9. 9. 　韓旭東, 黃慮. 深部真菌感染的臨床和實(shí)驗(yàn)室診斷方案[J]. 上海醫(yī)藥, 2004, (10): 441-443.
  10. 10. 　周庭銀. 臨床微生物學(xué)診斷與圖解[M]. 2版. 上海: 上?？茖W(xué)技術(shù)出版社, 2007: 318-319.
  11. 11. 　Medeiros EA, Lott TJ, Colombo AL, et al. Evidence for a pseudo-outbreak of Candida guilliermondii fungemia in a university hospital in Brazil[J]. J Clin Microbiol, 2007, 45(3): 942-947.
  12. 12. 　Girmenia C, Pizzarelli G, Cristini F, et al. Candida guilliermondii fungemia in patients with hematologic malignancies[J]. J Clin Microbiol, 2006, 44(7): 2458-2464.
  13. 13. 　Peman J, Bosch M, Canton E, et al. Fungemia due to Candida guilliermondii in a pediatric and adult population during a 12-year period[J]. Diagn Microbiol Infect Dis, 2008, 60(1): 109-112.
  14. 14. 　Miranda LN, van der Heijden IM, Costa SF, et al. Candida colonisation as a source for candidaemia[J]. J Hosp Infect, 2009, 72(1): 9-16.
  15. 15. 　Pfaller MA, Diekema DJ. Rare and emerging opportunistic fungal pathogens: concern for resistance beyond Candida albicans and Aspergillus fumigatus[J]. J Clin Microbiol, 2004, 42(10): 4419-4431.
  16. 16. 　Pfaller MA, Diekema DJ, Mendez M, et al. Candida guilliermondii, an opportunistic fungal pathogen with decreased susceptibility to fluconazole: geographic and temporal trends from the ARTEMIS DISK antifungal surveillance program[J]. J Clin Microbiol, 2006, 44(10): 3551-3556.
  17. 17. 　Barchiesi F, Spreghini E, Tomassetti S, et al. Effects of caspofungin against Candida guilliermondii and Candida parapsilosis[J]. Antimicrob Agents Chemother, 2006, 50(8): 2719-2727.
  18. 18. 　Canton E, Peman J, Sastre M, et al. Killing kinetics of caspofungin, micafungin, and amphotericin B against Candida guilliermondii[J]. Antimicrob Agents Chemother, 2006, 50(8): 2829-2832.
  19. 19. 　Pfaller MA, Boyken L, Hollis RJ, et al. In vitro susceptibility of invasive isolates of Candida spp. to anidulafungin, caspofungin, and micafungin: six years of global surveillance[J]. J Clin Microbiol, 2008, 46(1): 150-156.
  20. 20. 　Savini V, Catavitello C, Di MI, et al. Pan-azole-resistant Candida guilliermondii from a leukemia patient’s silent funguria[J]. Mycopathologia, 2010, 169(6): 457-459.
  21. 21. 　Pfaller MA, Boyken L, Hollis RJ, et al. In vitro activities of anidulafungin against more than 2, 500 clinical isolates of Candida spp. , including 315 isolates resistant to fluconazole[J]. J Clin Microbiol, 2005, 43(11): 5425-5427.
  22. 22. 　Ostrosky-Zeichner L, Rex JH, Pappas PG, et al. Antifungal susceptibility survey of 2000 bloodstream Candida isolates in the United States[J]. Antimicrob Agents Chemother, 2003, 47(10): 3149-3154.
  23. 23. 　Kabbara N, Lacroix C, de Latour RP, et al. Breakthrough C, parapsilosis and C. Guilliermondii blood stream infections in allogeneic hematopoietic stem cell transplant recipients receiving long-term caspofungin therapy[J]. Haematologica, 2008, 93(4): 639-640.