侵袭性念珠菌病血液培养对侵入性念珠菌病的诊断价值非常有限念珠菌血症深部念珠菌病在培养中更难被发现急性播散性导管相关的在深层组织/部念珠菌血症念珠菌血症位的念珠菌血症Modifiedfrom:RexJHetal.AdvInternMed43:321-71,1998ClancyCL,etal.ClinInfectDis56:1284-92,2013
侵袭性念珠菌病 念珠菌血症 深部念珠菌病 导管相关的 念珠菌血症 急性播散性 念珠菌血症 在深层组织/部 位的念珠菌血症 Modified from: Rex JH et al. Adv Intern Med 43:321-71, 1998. Clancy CL, et al. Clin Infect Dis 56:1284-92, 2013. 在培养中更难被发现 血液培养对侵入性念珠菌病的诊断价值非常有限 11
嗜中性粒细胞减少症患者在抗肿瘤化疗后IFI的诊断Prolonged (persistingafter24daysofbroad-spectrum antibiotcs)febrileneutroneniaEvaluationofdeepmycosisindicationsincludingbioodtest,symptoms,andsignsigevalualionshcdbeimplemenledrrespoctiveofthcpresence of findings other than febrie neutropenieunresponsivetobroad-specfrumantibioficsChestCTRightSerologicaltestBiood culturehypochandraigiaandHalosignsincreasedserumAir-crescent signsSinusitisAl-Pin.neutrophil血培养Cavitylesions,symptomsrecoverystageGMantigenWedge-shaped1+opacitiesAbdominalultraProvendiagnosisOkβ-D-glucansoundgraphycandidemiaAbdominalCTParanasal sinusCTandMRI念珠菌血Buits eye signHepatosplenicDestuctiandf症的确诊microabscessSssitlediagnosisorsinus wallBronchoscopymold infecton+ClinitallyClinicallydiagnosedGMantigenchronicdiagnosedarcytologyPuncturefluidBALdisseminatedinvasiveculture'saFouureFunduscopycandidiasisaspergillosisOcularsymptomsPuncture fluidBiopsycultureLungbiopsyBiopsy+Proven diagnosisProvendiagnosisProvenofmucomycosisof invasiveProvendiagnosis ofaspergilosisdagnosisofchronicCandidadisseminatedendophthalmitiscandidiasis+PositiveNegative.1Perfomedincaseswheretheriskofhemorrhageislow,wherethediagnosis cannotbe established by bronchoalveolar lavage (BAL),andwheretheresponsetotreatmentispoor*2If a positive GMantigen test is obtained,even with.negativechest CTfindings,paranasal sinus CT imaging should be considered.12*3WhenMucoris detectedintheparanasalsinus,thisconditiondeemsthecase as a clinically diagnosed mucormycosis.MedmvcolJ57E117-163..2016
Med mycol J 57E117-163, 2016. 嗜中性粒细胞减少症患者在抗肿瘤化疗后IFI的诊断 血培养 念珠菌血 症的确诊 12
基于血培养的真菌诊断TABLE 2.Number of blood cultures required todetectcommonmicroorganisms causingunimicrobialbacteremia and fungemiaFour blood cultures obtainedThree blood cultures obtainedCumulative %detectedbyCumulative % detected byMicroorganism(s)No.ofBSINo.ofBSIculture no.:culrure no.:episodesepisodes23235419397758793100100100S.aureus417164851009810066Coagulase-negativestaphylococci36674768878089100100Enterococcusspp7785208526100100Streptococci72439195206510090100Escherichia coli78254090981007688100Klebsiellapneumoniae156085166294100100acriginosa15白色念珠菌206085956083100100Calbicans758810801008100Candida glabrata光滑念珠菌√多达4个的血培养是必须的（从身体的不同部位取样），这可以使真菌血症的检出率提高到90%以上，13LeeA,etal.JClinMicrobiol45(11):3546-3548,2007
基于血培养的 真菌诊断 ✓ 多达4个的血培养是必须的（从身体的不同部位取样），这可以使真菌血症 的检出率提高到90%以上。 Lee A, et al. J Clin Microbiol 45(11):3546–3548, 2007. 白色念珠菌 光滑念珠菌 13
血培养阳性的时间可以作为导管相关念珠血症的特征Definite catheter related1.0scandidemia1NOJYes0.80.6LogranktestP<0.0010.4外周血血培养报阳时间超过30小时可以帮助排除血管内导管作为可能0.2的念珠菌血症的病源。10.00.0020.0040.0060.0080:00100.00120.00Timetopositivity (hours)TABLE3.AccuracyofaTTPcutoffof30hforthediagnosisofCRCin50patientswithindwellingCVCsNo.ofpatientswithCRCdiagnosis with the followingSensitivitySpecificiryArea underPatient groupPPV (%)NPV (%)TTPcutof:(%)(%)ROCcurveTIP≤30hTTP>30 h13BDefinite CRC10051.441.91000.7618Possible +non-CRC37275.957.171.063.20.66Definite+possibleCRCNon-CRC14Ben-AmiR,etal.JClinMicrobiol46:2222-6,2008
✓ 外周血血培养报阳时间超过30小时 可以帮助排除血管内导管作为可能 的念珠菌血症的病源。 血培养阳性的时间可以作为导管相关念珠血症的特征 Ben-Ami R, et al. J Clin Microbiol 46:2222-6, 2008. 14
加入特殊的真菌培养基可以提高念珠菌败血症病菌的生长速度&复苏速度JoURNALOF CLINICAL MICROBIOL.OGY,SepL.2007,P,3062-3064Vol.45,No.90095-1137/07/S08.00+0doi:10.1128/JCM.00966-07Detection ofFifteen Species of Candida in an AutomatedBloodCulture SystemLynn L.Horvath,*Benjamin J.George,and Duane R.HospenthalDeparmentofMedicine,BrookeAmyMedical Center,FortSamHouston,TexasReceived9May2007/Returnedformodification11June2007/Accepted28June2007Candidemia was simulated with 15 Candida spp.by using an automated blood culture system. Candidagrowth wasdetected in479/648(74%)bottles:211/216(98%)aerobicbottles,58/216(27%)anaerobicbottlesand 210/216 (97) mycology bottles.Only thegrowth of Candida lipolytica failed to be detected in all media.TABLE1.Number of Candida isolates with growth detected by the BacT/ALERT3DsystemNo, (%) of isolates detected in the following media with the indicated inoculaa:Candida spp.Mycology medium (MB)Aerobic medium (FA)Anaerobic medium (SN)(no. of isolates)All media10101001001010010001,0001,00055555555503.o5555555555525559nnnnnnnnnnnnnnng5:5555515755555553525551nnnnnnnnnmn2nnngC atbicans (5)43 (96)04C. dubliniensis (5)34 (76)00030 (67)C famata (5)oni0515Cfimetaria (5)31 (69)45(100)C glabrata (5)005555331Cguilliermondi (5)31 (69)1321101NOCinconspicua (5)33(73)C kefr (5)36(80)C. krusei (5)32 (71)0200.00C.lipolyrtica (5)19(42)525559203525558C lusitaniae (5)35 (78)012 (67)Cnonegensis (2)0030 (67)Cparapsilosis(5)ON012931 (69)Cnugosa (5)135 (78)C.tropicalis (5)677270721428707016Total (72) Inoculum size in CFU per blood cultrure bortle, Each Candida species except C norvegensis had 45 bottles, C.- nonvegensir had only 18.15C glabrata was the only speciesfor which 100%growth was detected in all media at all inoculum sizes.C C. lipolyrica had the lowest growth detection rate (42%) of any of the Cansdida species
加入特殊的真菌培养基可以提高念珠菌败血症病菌的生长速度&复苏速度 15