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我国霉菌感染流行病学分析：多中心回顾性研究

Epidemiology of Clinical Mold Infections in China: A Multicenter Retrospective Study

    摘要
  • 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.

     

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