Epidemiology of Clinical Mold Infections in China: A Multicenter Retrospective Study
-
摘要:
目的 分析我国霉菌感染的流行病学现状。 方法 选取2019年1月—2022年6月中国医院侵袭性真菌病监测网中19家参与单位的霉菌感染患者临床资料,采用WHONET软件分析霉菌菌种构成及临床感染情况等流行病学特征。 结果 共纳入16 285例霉菌感染患者,其中男性患者占比(62.1%)高于女性患者(37.9%);以老年患者为主,年龄中位数为60岁,年龄≥61岁患者占比49.3%(8023/16 285);主要分布科室为内科、ICU及外科;标本类型以下呼吸道标本为主(81.7%),其次为脓液及分泌物标本(7.8%);霉菌菌种构成以曲霉属为主(84.8%),青霉属、镰刀菌属、毛霉目和赛多孢霉占比分别为5.1%、3.0%、1.3%和0.4%;霉菌引起的常见感染性疾病中,下呼吸道感染霉菌以曲霉属为主(88.7%),其中烟曲霉最为常见(47.8%);耳部感染霉菌中曲霉属占比高达98.7%,其中土曲霉占比最高(39.7%);眼部感染霉菌中镰刀菌属占比最高(54.6%)。 结论 霉菌引起的下呼吸道、耳部和眼部感染的主要菌种分别为烟曲霉、土曲霉和镰刀菌属,在临床治疗时需注意不同部位霉菌感染的菌种分布差异。 Abstract:Objective To study the epidemiology of mold infections in China. Methods Based on the surveillance data of 19 hospitals participating in the China Hospital Invasive Fungal Surveillance Net from Jan 2019 to Jun 2022, the general information of patients and the epidemiological characteristics such as the proportion of different strains and clinical infection were analyzed by WHONET software. Results A total of 16 285 mold infection cases were included in the analysis, of which 49.3% were patients aged 61 and over, with the median age of 60 years old. The proportion of males was significantly higher than that of females (62.1% vs. 37.9%). The patients were mainly from the internal medicine, ICU and surgical wards. Most strains were isolated from lower respiratory tract, accounting for 81.7%, followed by pus and secretions (7.8%). In terms of species distribution, Aspergillus spp. accounted for the highest proportion (84.8%), with Penicillium spp., Fusarium spp., order Mucorales and Sedosporium spp. accounting for 5.1%, 3.0%, 1.3% and 0.4%, respectively. For species distribution among different mold infection, 88.7% of lower respiratory tract mold infections were caused by Aspergillus spp., and Aspergillus fumigatus(47.8%) was the most common species. Otomycosis was mainly caused by Aspergillus spp.(98.7%), of which Aspergillus terreus accounted for 39.7%, and ophthalmomycosis was mainly caused by Fusarium spp.(54.6%). Conclusions By the retrospective analysis of mold isolation from multicenter in China, we found that Aspergillus fumigatus, Aspergillus terreus, and Fusarium spp. were the most common species causing pneumonomycosis, otomycosis, and ophthalmomycosis, respectively. Therefore, it is necessary to pay attention to the differences in species distribution among different mold infections in clinical empirical treatment of fungal infections. -
Key words:
- fungi /
- mold /
- infection /
- epidemiology
作者贡献:张丽负责研究方案设计、数据分析及论文撰写;康梅、陈中举、曹存巍、马玲、朱敏、金炎、夏云、褚云卓、刘文恩、郭大文、黄颖、段金菊、王俊瑞、徐雪松、马筱玲、李彬、廖康和朱鹏飞负责实验操作和数据采集;王瑶、徐英春和明亮负责数据审核及论文审校。利益冲突:所有作者均声明不存在利益冲突 -
表 1 16 285例霉菌感染患者一般临床资料[n(%)]
项目 数值 性别 女性 6176(37.9) 男性 10 109(62.1) 年龄(岁) 0~1 96(0.6) 2~10 186(1.1) 11~20 302(1.9) 21~40 2000(12.3) 41~60 5678(34.9) 61~80 6841(42.0) ≥81 1182(7.3) 科室 内科 8297(50.9) ICU 2817(17.3) 外科 1520(9.3) 五官科 1086(6.7) 急诊科 920(5.6) 皮肤科 462(2.8) 儿科 188(1.2) 其他科室 995(6.2) 表 2 16 285株霉菌菌种构成及标本分布[n(%)]
项目 数值 菌种构成 曲霉属 13 806(84.8) 青霉属 831(5.1) 镰刀菌属 493(3.0) 毛霉目 206(1.3) 赛多孢霉 57(0.4) 其他 892(5.5) 标本类型 下呼吸道 13 305(81.7) 脓液及分泌物 1272(7.8) 耳部 300(1.8) 眼部 207(1.3) 组织 221(1.4) 体液 150(1.0) 血液 53(0.3) 其他 777(4.8) 表 3 曲霉属菌种构成[n(%)]
菌种 数值 烟曲霉 6819(49.4) 黄曲霉 3574(25.9) 黑曲霉 1645(11.9) 土曲霉 547(4.0) 构巢曲霉 160(1.1) 杂色曲霉 121(0.9) 棒曲霉 7(0.1) 灰绿曲霉 7(0.1) 其他曲霉属 926(6.6) 总计 13 806(100) 表 4 毛霉目种属构成[n(%)]
种属 数值 毛霉属 96(46.6) 根霉属 68(33.0) 根毛霉属 20(9.7) 横梗霉属 16(7.8) 小克银汉霉属 6(2.9) 总计 206(100) -
[1] Bongomin F, Gago S, Oladele RO, et al. Global and Multi-National Prevalence of Fungal Diseases: Estimate Precision[J]. J Fungi (Basel), 2017, 3: 57. doi: 10.3390/jof3040057 [2] WHO fungal priority pathogens list to guide research, development and public health action[M]. World Health Organization, 2022. [3] von Lilienfeld-Toal M, Wagener J, Einsele H, et al. Inva-sive Fungal Infection[J]. Dtsch Arztebl Int, 2019, 116: 271-278. [4] Wang H, Wang Y, Yang QW, et al. A national survey on fungal infection diagnostic capacity in the clinical mycology laboratories of tertiary care hospitals in China[J]. J Microbiol Immunol Infect, 2020, 53: 845-853. doi: 10.1016/j.jmii.2020.03.016 [5] Xiao M, Chen SC, Kong F, et al. China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study Group. Five-year China Hospital Invasive Fungal Surveillance Net (CHIF-NET) study of invasive fungal infections caused by noncandidal yeasts: species distribution and azole susceptibility[J]. Infect Drug Resist, 2018, 11: 1659-1667. [6] Wang Q, Cai X, Li Y, et al. Molecular identification, antifungal susceptibility, and resistance mechanisms of patho-genic yeasts from the China antifungal resistance surveillance trial (CARST-fungi) study[J]. Front Microbiol, 2022, 13: 1006375. doi: 10.3389/fmicb.2022.1006375 [7] Firacative C. Invasive fungal disease in humans: are we aware of the real impact?[J]. Mem Inst Oswaldo Cruz, 2020, 115: e200430. doi: 10.1590/0074-02760200430 [8] Rotjanapan P, Chen YC, Chakrabarti A, et al. Epidemio-logy and clinical characteristics of invasive mould infections: A multicenter, retrospective analysis in five Asian countries[J]. Medical Mycol, 2018, 56: 186-196. doi: 10.1093/mmy/myx029 [9] Wei L, Zhu P, Chen X, et al. Mucormycosis in Mainland China: A Systematic Review of Case Reports[J]. Mycopathologia, 2022, 187: 1-14. doi: 10.1007/s11046-021-00607-4 [10] Vallabhaneni S, Benedict K, Derado G, et al. Trends in Hospitalizations Related to Invasive Aspergillosis and Mucormycosis in the United States, 2000—2013[J]. Open Forum Infect Dis, 2017, 4: ofw268. doi: 10.1093/ofid/ofw268 [11] Krishna V, Bansal N, Morjaria J, et al. COVID-19-Associated Pulmonary Mucormycosis[J]. J Fungi, 2022, 8: 711. doi: 10.3390/jof8070711 [12] Song Y, Liu X, Yang Z, et al. Molecular and MALDI-ToF MS differentiation and antifungal susceptibility of prevalent clinical Fusarium species in China[J]. Mycoses, 2021, 64: 1261-1271. doi: 10.1111/myc.13345 [13] 孙声桃, 吕奇学, 韩雷, 等. 我国中原地区653株真菌性角膜炎分离镰刀菌的基因型及药物敏感性[J]. 中华眼科杂志, 2015, 51: 660-667. doi: 10.3760/cma.j.issn.0412-4081.2015.09.005 [14] 杨之辉, 余进, 李若瑜. 中国大陆地区赛多孢霉感染流行现状的回顾性分析[J]. 中国真菌学杂志, 2019, 14: 183-188, 192. doi: 10.3969/j.issn.1673-3827.2019.03.014 [15] Chen M, Zhu X, Cong Y, et al. Genotypic diversity and antifungal susceptibility of Scedosporium species from clinical settings in China[J]. Mycoses, 2022, 65: 1159-1169. doi: 10.1111/myc.13507 [16] Paulussen C, Hallsworth JE, álvarez-Pérez S, et al. Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species[J]. Microb Biotechnol, 2017, 10: 296-322. doi: 10.1111/1751-7915.12367 [17] Jeong W, Keighley C, Wolfe R, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports[J]. Clin Microbiol Infec, 2019, 25: 26-34. doi: 10.1016/j.cmi.2018.07.011 [18] Jing R, Yang WH, Xiao M, et al. Species identification and antifungal susceptibility testing of Aspergillus strains isolated from patients with otomycosis in northern China[J]. J Microbiol Immunol Infect, 2022, 55: 282-290. doi: 10.1016/j.jmii.2021.03.011 [19] Gharaghani M, Seifi Z, Zarei Mahmoudabadi A. Otomycosis in Iran: A Review[J]. Mycopathologia, 2015, 179: 415-424. doi: 10.1007/s11046-015-9864-7 [20] Lin Y, Zhang J, Han X, et al. A retrospective study of the spectrum of fungal keratitis in southeastern China[J]. Ann Palliat Med, 2021, 10: 9480-9487. doi: 10.21037/apm-21-1949