Objective To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea (AAD) in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy. Methods Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015. Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed. Results Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients (15.9%) in whom were infected with toxin-producing Clostridium difficile. Type A+B+, type A-B+, and type A+B- accounted for 35.7% (10/28), 35.7% (10/28) and 28.6% (8/28), respectively. Fifty-four patients (42.9%) with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6% (26/126), and the others were Candida glabrata (n=11), Candida tropical (n=10), Candida parapsilosis (n=3), Saccharomyces cerevisiae (n=2), Pichia pastoris (n=1), and Kodamaea ohmeri (n=1). Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients (2.4%). The main antibiotics used in AAD ppatients were penicillins, carbapenems, third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder. Conclusion The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.
Objective To explore the value of procalcitonin (PCT) in differential diagnosis of invasive candidiasis. Methods PubMed, Embase, Medline, Cochrane Library, China National Knowledge Infrastructure and Wanfang Data were searched for articles published from the dates of establishment of databases to January 2021. A prospective and retrospective cohort studies and a case-control studies of PCT in differential diagnosis of invasive candidiasis were collected. RevMan 5.3 software QUADAS-2 risk assessment tool was used to evaluate the quality of the literature. Meta-Disc 1.4 software was used to determine whether the original data had threshold effect and heterogeneity. Stata 14.0 software was used to analyze meta, judge publication bias and draw Deeks diagram. Results A total of 9 articles and 943 patients were included. There were 259 cases in candida group and 684 cases in control group. The study showed that the total sensitivity was 0.86 [95% confidence interval (CI) (0.80, 0.91)], specificity was 0.78 [95%CI (0.70, 0.84)], positive likelihood ratio was 3.92 [95%CI (2.77, 5.55)], negative likelihood ratio was 0.18 [95%CI (0.12, 0.27)], the area under receiver operator characteristic curve was 0.90 [95%CI (0.87, 0.92)], diagnostic odds ratio was 19.75 [95%CI (10.71, 36.43)]. The results of heterogeneity test showed that there was heterogeneity caused by non-threshold effect between studies. The results of subgroup analysis showed that the heterogeneity I2 value of PCT<2 ng/mL subgroup decreased significantly, and the result was more stable, with sensitivity. The results show that sensitivity was 0.86 [95%CI (0.79, 0.91)], specificity was 0.72 [95%CI (0.63, 0.80)], the area under receiver operator characteristic curve was 0.87 [95%CI (0.83, 0.89)]. Conclusions Serum PCT in the differential diagnosis of invasive candidiasis has certain accuracy and negative predictive value. However, PCT is only an auxiliary test. The differential diagnosis of invasive candidiasis should be combined with clinical features and other diagnostic indexes.
Candida auris is an emerging multidrug-resistant fungus that has become a significant global public health threat due to its strong resistance to antifungal agents and its ability to spread within healthcare facilities. This paper reviews the global epidemiological trends of Candida auris and the current status of existing prevention and control systems, focusing specifically on pathogen epidemiological characteristics, domestic and international epidemic situations, current prevention and control frameworks, and the construction of prevention networks. In response to the challenges posed by the international spread of Candida auris , China’s fungal disease prevention system should advance towards a more systematic and scientific direction. By integrating resources from medical institutions, disease control agencies, and research institutes, and combining multidisciplinary knowledge and technologies, China should establish a multi-level coordinated prevention and control mechanism to improve its monitoring, prevention, and treatment systems. In the future, China’s fungal disease prevention and control system needs to further strengthen talent cultivation, improve surveillance networks, promote technological innovation, and build a comprehensive, multi-level modern prevention and control system.
Objective To evaluate the clinical features, risk factors and treatment outcomes of endogenous candida albicans endophthalmitis. Methods The clinical data of 11 patients (18 eyes) with vitreous specimen culture-proven endogenous candida endophthalmitis were retrospective reviewed, including risk factors, clinical features and therapeutic methods and outcomes. Results There were 4 males and 7 females patients, aged from 19 to 72 years with a mean age of （41.61plusmn;9.76）years. Seven patients had bilateral endophthalmitis. They had histories of induced abortion (2 patients), intravenous transfusion (3 patients), colon cancer surgery (1 patient), chemotherapy after surgery of malignant lymphoma of colon (1 patient), renal transplantation (1 patient), acute necrotic pancreatitis surgery (1 patient) and diabetes (1 patient). One patient has no special medical history. All patients had no history of ocular trauma or intraocular surgery. The major complaints included blurred vision, metamorphopsia and floaters. It taken an average of (15.23plusmn;8.70) days (3-38 days) for patients to go to the hospital after getting those symptoms. The main clinical manifestations included pre- or sub-retinal white exudates and vitreous inflammations.In 18 eyes, 11 received vitreous surgery, and the other 7 were treated by intravitreal administration of anti-fungal drugs. Ten patients also underwent systemic anti-fungal therapy. The candida endophthalmitis was cured for 10/11 patients and most of them with increased visual acuity. Conclusions Endogenous candida albicans endophthalmitis is characterized by pre- or sub-retinal white exudates and vitreous inflammations. Non-standard intravenous transfusion, induced abortion and malignancy are its major risk factors. Pars plana vitrectomy or intravitreal delivery of anti-fungal drugs can cure this disease.
【摘要】 目的 对季也蒙念珠菌感染患者的临床及微生物学特征进行分析，为临床诊治提供参考。 方法 收集2006年1月-2008年12月病原菌培养为季也蒙念珠菌的10例住院患者资料进行回顾性分析。 结果 季也蒙念珠菌感染患者存在多种基础疾病，大多数患者（8/10）有易感因素，其中7例使用广谱抗菌药物。10例中有8例为深部真菌感染。其临床表现与感染部位有关，主要累及泌尿道、呼吸道和皮肤软组织。多数深部感染患者（6/8）在感染前存在同部位细菌感染，部分患者（3/8）在相同部位还可分离出其他真菌。全部季也蒙念珠菌菌株对两性霉素B敏感，大多数菌株（9/10）对氟康唑敏感。仅1例患者因肺部感染、呼吸衰竭死亡，其余患者经氟康唑、伊曲康唑或特比萘芬等抗真菌药物治愈。 结论 季也蒙念珠菌感染多发生于有基础疾病、存在真菌易感因素者，感染部位多为原细菌感染部位，常合并其他细菌或真菌感染。部分菌株对氟康唑和伊曲康唑中敏或耐药，治疗应根据药敏进行选择。【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.
ObjectiveTo establish an in vitro model of Candida albicans-Staphylococcus epidermidis mixed species biofilm on polyvinyl chloride (PVC) material, and to observe mixed species biofilm formation and its microstructure. MethodsStaphylococcus epidermidis bacteria (ATCC35984) and Candida albicans fungal (ATCC10231)were co-incubated with 0.5 cm diameter PVC pieces in tryptic soy broth (TSB) to form mixed specie biofilms (experimental group). At 2, 6, 12, 24, 48, and 72 hours, the thicknesses of the biofilms, the number of bacteria per sight, and the percentage of viable cells in biofilms were measured, and three-dimensional images of biofilms were obtained using confocal laser scanning microscope (CLSM) and scanning electron microscope (SEM) at 48 hours. PVC material cultured in the TSB medium served as control group. ResultsIn control group, there was no pathogenic bacteria adhesion on the PVC material surface. In experimental group, CLSM showed that colonies and biofilm formation were found at 6 hours after co-culture, and gradually increased with time. The pathogenic bacteria colonies reached the peak at 24 hours, and biofilm thickness attained peak value at 48 hours. In experimental group, the number of colony was significantly different among 2, 6, and 24 hours, and between 2, 6 hours and 48, 72 hours (P<0.05), but no significant difference was found among 24, 48, and 72 hours (P>0.05). The biofilm thickness showed significant difference between the other time points (P<0.05) except between 48 and 72 hours (P>0.05). The percentage of viable cells in the outer layers of the biofilm was significantly higher than that in inner and middle layers at 48 hours (P<0.05). Three-dimensional reconstruction displayed that the surface of mixd species was uneven; living bacterium mainly located at the protuberance, and dead bacteria mainly located at the concaves. SEM image showed that Staphylococcus epidermidis attached to various forms of Candida albicans (spores, pseudohyphae, hyphae) gradually, and formed multilayer reticulate sophisticated structure on the surface of PVC with time. ConclusionCandida albicans-Staphylococcus epidermidis mixed species biofilm is sophisticated in structure. The combination of CLSM, SEM, and three-dimensional image reconstruction technology is ideal for investigation of mixed species biofilm on PVC material.