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

作　　者：张丽[1] 康梅[2] 陈中举 曹存巍[4] 马玲[5] 朱敏 金炎 夏云[8] 褚云卓[9] 刘文恩[10] 郭大文[11] 黄颖[12] 段金菊[13] 王俊瑞[14] 徐雪松[15] 马筱玲 李彬[17] 廖康[18] 朱鹏飞 王瑶[1] 徐英春[1] 明亮[19] ZHANG Li;KANG Mei;CHEN Zhongju;CAO Cunwei;MA Ling;ZHU Min;JIN Yan;XIA Yun;CHU Yunzhuo;LIU Wenen;GUO Dawen;HUANG Ying;DUAN Jinju;WANG Junrui;XU Xuesong;MA Xiaoling;LI Bin;LIAO Kang;ZHU Pengfei;WANG Yao;XU Yingchun;MING Liang(Department of Laboratory Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Laboratory Medicine,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Laboratory Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Dermatology and Venereology,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Clinical Laboratory,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Medical Mycology Center,Department of Dermatology,Huashan Hospital,Fudan University,Shanghai 200040,China;Clinical Laboratory,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Laboratory Medicine,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Department of Clinical Laboratory,The First Hospital of China Medical University,Shenyang 110001,China;Department of Clinical Laboratory,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Clinical Laboratory,the First Affiliated Hospital of Harbin Medical University,Harbin 110015,China;Department of Clinical Laboratory,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Pharmacy,the Second Hospital of Shanxi Medical University,Taiyuan 030013,China;Affiliated Hospital of Inner Mongolian Medical University,Hohhot 010050,China;Department of Clinical Laboratory,China-Japan Union Hospital of Jilin University,Changchun 130033,China;Department of Clinical Laboratory,The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hosp

机构地区：[1]中国医学科学院北京协和医院检验科,北京100730 [2]四川大学华西医院实验医学科,成都610041 [3]华中科技大学同济医学院附属同济医院检验科,武汉430030 [4]广西医科大学第一附属医院皮肤科,南宁530021 [5]华中科技大学同济医学院附属协和医院检验科,武汉430022 [6]复旦大学附属华山医院皮肤科真菌室,上海200040 [7]山东第一医科大学附属省立医院检验科,济南250021 [8]重庆医科大学附属第一医院检验科,重庆400016 [9]中国医科大学附属第一医院检验科,沈阳110001 [10]中南大学湘雅医院检验科,长沙410008 [11]哈尔滨医科大学附属第一医院检验科,哈尔滨110015 [12]安徽医科大学第一附属医院检验科,合肥230022 [13]山西医科大学第二医院药学部,太原030013 [14]内蒙古医科大学附属医院检验科,呼和浩特010050 [15]吉林大学中日联谊医院检验科,长春130033 [16]中国科学技术大学附属第一医院(安徽省立医院)检验科,合肥230001 [17]福建医科大学附属协和医院检验科,福州350001 [18]中山大学附属第一医院医学检验科,广州510080 [19]郑州大学第一附属医院检验科河南省检验医学重点实验室,郑州450052

出　　处：《协和医学杂志》2023年第3期559-565,共7页Medical Journal of Peking Union Medical College Hospital

基　　金：国家自然科学基金(82172351);中央高水平医院临床科研专项(2022-PUMCH-A-137);中国医学科学院医学与健康科技创新工程(2021-I2M-1-044)。

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16285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%(8023/16285);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。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 propor⁃tion of different strains and clinical infection were analyzed by WHONET software.Results A total of 16285 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 isola⁃ted 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%,respec⁃tively.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 retro⁃spective 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 ophthal⁃momycosis,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.

关 键 词：真菌 霉菌 感染 流行病学 

分 类 号：R379[医药卫生—病原生物学] R181.23[医药卫生—基础医学]