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Candida infection in patients with hepatitis characteristics and drug sensitivity analysis_2963

By Debbie Nichols,2014-10-30 11:50
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Candida infection in patients with hepatitis characteristics and drug sensitivity analysis_2963

    Candida infection in patients with hepatitis characteristics and drug sensitivity analysis

     Author: Wang Han Song-fen Guo Tong Bao Chunmei Cui

    Zhang Juling Health embo

     Abstract Objective To analyze the patients with hepatitis

    infection and drug sensitivity of Candida to guide the clinical appropriate treatment. Methods API ATB system and the ATB FUNGUS kit, the 326 positive specimens for fungal culture and identification of Candida infection in drug susceptibility determination and analysis. Results in 326 specimens of fungi, Candida albicans accounted for 78.8% of the highest rate of infection, including Candida albicans Candida infections account for 75%. The detection rate of sputum specimens with the highest specimens of the various types of Candida

    infections accounted for 55%; antifungal 5 fluorocytosine,

    amphotericin B, nystatin, miconazole, econazole, and ketoconazole The sensitivity of Candida rates were 95%, 96%, 96%, 76%, 51% and 43%. Conclusion fungal infection in patients

    with hepatitis in order to account for the first candidiasis, fungal infection sites were respiratory tract mainly. Clinical use of drugs should be based on drug susceptibility testing of Candida albicans results of comprehensive analysis, correctly

    applied.

     Key words Candida; sensitivity; hepatitis

     The feature of Candida infections of the patients with hepatitis and their drug susceptibility analysis

     ABSTRACT Objective To investigate Candida infections of the patients with infected hepatitis virus and drug

    susceptibility in the 302th hospital of PLA for the guidance

    of rational use of antibiotics. Methods 326 fungus samples from the patients with hepatitis virus infection were determined by methods of API ATB system , part of their drug

    susceptibility were test with ATB FUNGUSR kit. Results The results showed that 22 species had been identified, and Candida was 78.8% in all fungi and Candida albicans is 75% of candidaial infections. The highest positive rate of samples was from sputum which was 55%. The sensitivity of Candida to 5

     fluorocytosine, amphotericine B, nystatine, miconazole, econazole and ketoconazole was 95%, 96%, 96%, 76%, 51% and 43% respectively. Conclusions The feature of Candida of the patients with hepatitis were the highest positive rate of

    fungal infections. We should pay more attentions to the treatment for the candidial infections and select antibiotic according to their drug susceptibility.

     KEY WORDS Candida; Drug susceptibility; Hepatitis

     Fungal nosocomial infection on the rise. According to reports, nearly 30 years the incidence of deep fungal infections has increased by 3 ~ 5 times, especially in immunocompromised populations increase. Patients with hepatitis, especially chronic hepatitis, liver cirrhosis,

    often a long course and the long hospital stay, generally low immunity, high-dose combination therapy highly micro-

    ecological imbalance caused by the body, making the conditions of endogenous pathogenic fungal infection riskIncrease. Of

    deep fungal infection occurs, often leads to a complex condition, diagnosis and treatment difficulties, and progress rapidly, a high fatality rate, so-called "death infection."

    The key is to improve the prognosis of patients with early diagnosis and proper treatment. As the clinical use of antifungal agents, fungi widespread emergence of drug resistance [1], to the treatment brings new challenges. Of different fungi to antifungal drug resistance is different from the results of drug sensitivity based on rational drug

    use become more important. Now in our hospital in recent years, the incidence of fungal infection in hospitalized patients and drug resistance make an analysis to provide a basis for clinical rational use of drugs.

     1 Materials and methods

     1.1 Materials 326 clinical isolates of fungi (the same position, except the same kinds of fungi), were from our hospital from 1998 to 2004 hospitalized patients with hepatitis. Specimens, including sputum, throat swab, stool, midstream urine, oral mucosa, blood and ascites of 7 types.

     1.2 Methods

     The sputum, throat swabs, midstream urine, stool and other specimens of routine immunization to the Sarbanes-slant

    medium, 30 ? culture, daily observation of colony morphology and color. Medium colony growth characteristics, morphological observation and identification of chromogenic culture media. Yeast-like fungus with the API ATB system for identification of fungi (the specific method of system operation according to API guidelines). Drug sensitivity test using ATB FUNGUS kit, ATB testing of fungi, including the positive control without antibiotics, and different antifungal agents, including 5

    fluorocytosine, amphotericin, nystatin, miconazole, econazole, and Ketoconazole. The measured strains with the preparation of sterile saline into the 6 × 108CFU/ml bacilli, with an

    automatic ATB recorder records, the results are classified into sensitive, intermediate, and resistance, and to reference strains of Candida albicans ATCC90028. Reposted elsewhere in the paper for free download http://

     2 Results

     2.1 Candida infection rate, the specimen source

     A total of 326 isolated fungi, including Candida 257, accounting for the number of fungal infections 78.8%. Candida species and specimens of the source in Table 1.

     Can be seen from Table 1, in all 257 cases of Candida infection samples, the largest proportion of Candida albicans (75%), followed by Candida tropicalis, Candida parapsilosis

    and Candida krusei, Candida infection accounted for the total number of 11%, 4% and 4%; in fungal infections in patients

    with type specimens in order to sputum-based, accounting for

    55%, followed by throat swab; oral candida infection outside to the middle of urine specimens more, accounting for 12% ; blood, ascites and lower rates of fungal infections.

     2.2 Sensitivity Analysis

     Candida to antifungal agents of the sensitivity analysis in Table 2. The results showed that Candida 5

    fluorocytosine, amphotericin and nystatin

     Table 1 257 samples of Candida infection of analysis

    (omitted)

     Overall sensitivity rate of better than miconazole, econazole, and ketoconazole.

     3 Discussion

     A wide range of fungi are widely distributed in nature, there are nearly 300 kinds of pathogenic and cause infection

    in hospital only a few dozens, mostly for the conditions of endogenous pathogenic infections, the current worsening of infection [2,3]. In recent years, due to hepatitis antibiotics, antifungals and liver transplant patients, immunosuppressive agents, hormone use, and an increase in

    cancer incidence; hepatitis in patients with longer duration, resistance is low, flora imbalance and other factors, so that hepatitis in patients with fungal infection on the rise. Candida fungal infection due to higher rates, so pay close

    attention.

     This results showed that patients with hepatitis infection Candida is a major fungal infection, accounting for

    78.8%; of which a maximum of Candida albicans (75%), followed by Candida tropicalis, Portugal, Candida, Candida

    guilliermondii, Candida and other native Candida are found in patients with hepatitis infection. Fungal infection sites were

    respiratory tract dominated, followed by the middle of urine; blood and ascites in patients with low infection rates. Candida albicans sensitivity to commonly used antifungal agents showed that pairs of 5 fluorocytosine, amphotericin

    and nystatin sensitivity of better (higher than 95%), but miconazole, econazole, and one itraconazole sensitivity rate was only 76%, 51% and 43%, may be related to characteristics of the drug in patients with hepatitis. In liver disease infection in the number of rare Candida guilliermondii,

    Candida native, light

     Table 2 the sensitivity of Candida albicans to antifungal agents slightly

     Slip infected by drug treatment of candidiasis, ketoconazole and econazole also clearly resistant, it is worth the attention of clinical medicine. Different types of Candida drug resistance are different strains of this group due to fewer in favor of one comparison, the need for further observation.

     Through the analysis of fungal infection in patients with hepatitis were identified in patients with hepatitis major pathogenic fungi - Candida albicans and their drug

    sensitivity. In therapeutic terms, Candida albicans of amphotericin B to select the best; for the treatment of Candida tropicalis with 5 fluorocytosine, nystatin and

    amphotericin B and the results have been very good; Nystatin is one of many beads mixed infection of bacteria, especially when the drug of choice, but should pay attention to in vitro susceptibility and in vivo anti-fungal effect is sometimes

    inconsistent, such as Portugal Candida to amphotericin and fluconazole natural resistance. Of suspected fungal infections in patients with susceptibility to strengthen inspection and monitoring of fungi, and combined with clinical efficacy in improving the prognosis of patients has important

significance.

     References

     [1] Ghannoum MA, Rex JH, Galgiani J N. Susceptibility testing of fungi: current status of correlation of in vitro data with clinical outcome [J]. J Clin Microbiol, 1996,34:489

     [2] Bonduel M, Santos P, Turienzo CF, et al. A typical skin lesions caused by Curoularia sp and Pseudallescheria boydii in two patients after allogeneic bone marrow transplantation [J]. Bone Marrow Transplant, 2001,27 (12): 1311

     [3] Gong Fu, Xu and three men, Xiang Qin, et al. Intensive Care Unit Investigation and analysis of yeast-like

    fungal infections [J]. China Hospital Infection Journal, 2003,13 (3): 282 reposted elsewhere in the paper for free download http: / /

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