10年肠道真菌培养结果分析

目的探讨浙江大学医学院第一附属医院住院患者肠道真菌分离状况与趋势变化。方法回顾分析2000年1月1日至2009年12月30日10年间在该院送检的住院患者粪便标本的真菌分离率、真菌种类和年度变迁变化特点。结果 10年间从送检全部疑似肠道真菌感染的2 344份粪便标本中共检到真菌1 456株,归属5属19种,每年的检出率在55.7%67.0%。分离菌株中以白色念珠菌（74.0%）占首位,其次是光滑念珠菌（11.4%）,再次是热带念珠菌（7.1%）,光滑念珠菌和热带念珠菌分离率分别从2000年的4.9%、6.6%上升到2009年的16.8%、10.6%,呈上升趋势。结论该院10年间肠道真菌的分离率较高,白色念珠菌的分离率一直位于首位,非白色念珠菌的分离率处于上升趋势。     

IgA肾病与膜性肾病患者肠道微生物菌群结构分析

【背景】越来越多的证据表明肠道失衡与免疫介导的疾病相关,但肠道菌群和免疫介导的肾脏疾病之间的关系仍不清楚。【目的】通过Illumina高通量测序方法对IgA肾病(immunoglobulin A nephropathy, IgAN)、膜性肾病(membranous nephropathy, MN)患者和健康人群的肠道菌群进行比较。【方法】回顾性选择2020年9月–2021年12月期间,在甘肃省人民医院肾内科行肾穿刺活检并诊断为IgAN及MN患者的新鲜粪便标本,分别编号为IgAN组和MN组,收集体检中心健康人群粪便标本作为健康对照组,每组样本为10例。采用高通量测序技术对粪便样本中所有细菌的16S rRNA基因V3-V4区进行DNA测序,然后进行分类操作单元(operational taxonomic units, OTU)、物种分类、α多样性、β多样性等分析,比较3组之间的肠道菌群差异。【结果】与健康对照组相比,门水平上IgAN组的变形菌门(Proteobacteria)和放线菌门(Actinobacteria)比例明显增高,分别为18%vs. 4%和18.3%vs. 5%;属水平上I...     

石棉地区藏族、彝族和汉族人群肠道微生物菌群构成与分布

目的探讨石棉地区藏族、彝族和汉族人群肠道微生物菌群构成分布情况。方法将2017年7月至2019年7月在我院进行健康体检的并符合纳入和排除标准的125例健康人作为研究对象,其中汉族65例,彝族32例,藏族28例。收集受试健康人群清晨空腹粪便标本,利用高通量测序技术测定石棉地区藏族、彝族和汉族人群粪便样本16S rRNA序列并建立分类操作单元(OTU),分析肠道微生物结构特征及优势菌群,并对各民族人群肠道微生物进行聚类分析。结果共获得514 069条高质量16S rRNA序列,每个样品平均生成序列数为(4 112.55±1 258.67)条;97%相似度归并共获得68 232个OTU,每个样品平均OTU为(545.86±157.49)个;石棉地区汉族人群粪便标本中占优势细菌门为拟杆菌门和厚壁菌门,彝族及藏族人群粪便标本占优势细菌门为厚壁菌门和拟杆菌门,菌门水平上丰富度差异存在统计学意义(F=13.810,P0.001;F=17.797,P0.001);石棉地区汉族人群粪便标本优势细菌属为拟杆菌属、栖粪杆菌属,彝族及藏族人群粪便标本优势细菌属为普氏菌属、栖粪杆菌属和拟杆菌属,在拟杆菌属和栖粪杆菌属水平上丰富度差异存在统计学意义(F=39.836,P0.001;F=141.194,P0.001);石棉地区彝族和藏族与汉族人群肠道微生物差异度48%。结论石棉地区藏族和彝族与汉族人群间肠道微生物优势细菌门及细菌属虽相似但在丰富度上存在差异,汉族健康人群肠道微生物菌群呈现不规律、分散聚类现象,彝族、藏族健康人群肠道微生物菌群呈现集中聚类现象,临床应根据种族差异对人群进行膳食指导以调控肠道微生态平衡。     

外科深部真菌感染的病原学分析

目的分析外科住院患者合并真菌感染状况。方法分离的真菌用API 20C AUX真菌鉴定条,用ATB FUNGUS-2进行药敏试验。结果真菌的种类分布中第1位是白色念珠菌占53%,第2位是热带念珠菌占20%,第3位是光滑念珠菌占14%,第4位是近平滑念珠菌占4%,第5位是其余念珠菌占2%;真菌在外科各区分布中,外科ICU占42%,移植外科占25%;真菌在各类标本分布中,痰占43%,尿液占13%,粪便占10%,引流液占9%,血液占7%;真菌对药物5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑的药物敏感性分别是93%、98.9%、90.8%、59.8%。结论外科真菌感染集中在重症病区(ICU),分离的致病真菌主要是白色念珠菌、热带念珠菌、光滑念珠菌,真菌对两性霉素B敏感性最高。     

老年慢性阻塞性肺疾病患者肺部感染病原菌与肠道定植菌的关系

目的探讨老年慢性阻塞性肺疾病(COPD)患者肺部感染病原菌与肠道定植菌的关系,为后续研究提供参考。方法选择2018年7月至2019年7月我院呼吸内科收治的60例COPD患者作为研究对象,根据是否合并肺部感染将患者分为感染组(n=38)和未感染组(n=22)。收集患者痰和粪便标本进行细菌培养,比较两组患者痰和粪便细菌检出情况,并对痰培养及粪便培养结果进行直线相关回归分析。结果感染组患者痰标本中铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌及大肠埃希菌检出率高于未感染组(均P0.05)。感染组患者粪便标本中铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、阴沟肠杆菌、肠球菌、金黄色葡萄球菌检出率高于未感染组,肺炎链球菌检出率低于未感染组(均P0.05)。感染组患者粪便中各细菌检出率与痰培养细菌检出率呈正相关(r=0.745,P=0.009)。未感染组患者粪便中各细菌检出率与痰培养细菌检出率无显著相关性。结论老年COPD合并肺部感染患者病原菌与肠道定植菌具有一定相关性,临床治疗中应重视COPD患者肠道微生态平衡以降低肺部感染发生率。     

ICU医院内深部真菌感染临床分析

目的研究ICU深部真菌感染的临床及病原学特点。方法收集129例ICU深部真菌患者的血、痰、粪便、尿、腹腔引流液培养结果及其临床资料。结果129例ICU深部真菌患者中共分离出152株真菌,以白色念珠菌及热带念珠菌为主,其中白色念珠菌占55．92％,热带念珠菌占21．71％。感染部位以尿路感染最常见,占50．66％,其次为呼吸道感染,占29．61％。结论ICU深部真菌感染菌种和部位有自己的特点,并且有一定的诱发因素,应予以高度重视。     

亚成体大熊猫肠道真菌的分离与鉴定

目的探讨大熊猫肠道真菌菌群结构,为研究肠道真菌对纤维素的降解和控制肠道真菌病奠定基础。方法采用PDA、SDA、高氏3种培养基对8只亚成体大熊猫新鲜粪便进行真菌分离、纯化,经形态学和分子生物学方法进行鉴定。结果经培养获得的真菌主要由4种霉菌(Galactomyces geotrichum占22.74%、Galactomyces reessii占12.37%、Mucor ramosissimus占18.23%和Mucor circinelloides占6.39%)和2种酵母菌(Trichosporon sp.占19.46%和Candida solani strain占20.81%)组成,各样品中真菌所占比例不等。且3种培养基的分离效果显示PDASDA高氏培养基。结论亚成体大熊猫肠道内存在一定比例的可培养真菌。     

糖尿病患者阴道真菌菌群结构与生态分布研究

目的 探讨糖尿病(DM)患者阴道真菌菌群结构和生态分布特点.方法 采用真菌18S rDNA克隆文库法,对不同血糖控制情况下DM患者的阴道真菌18S rDNA序列进行克隆和测序,构建阴道真菌18S rDNA克隆文库,建立系统发育树,获取DM患者阴道真菌菌群的结构和组成特征.结果 DM患者和健康妇女阴道标本中存在3个真菌类群14个属共20个种系型的真菌菌群.健康妇女(H组)、HbA1c＜6.5％患者(DMa组)、HbA1c6.5％～7.5％患者(DMb组)和HbA1c＞7.5％患者(DMc组)的阴道真菌菌落分别存在7、9、13和16个OTUs.念珠菌属为各组研究对象阴道真菌菌群的优势菌属,其阳性克隆子在H组、DMa组、DMb组和DMc组的比例呈上升趋势.DM患者阴道白色念珠菌、光滑念珠菌和克柔念珠菌的比例不同程度升高,而阴道酿酒酵母菌和Uncultured fungi的比例显著降低(P＜0.05),伴随其他一些真菌菌种的出现和比例改变.结论 DM患者阴道真菌菌群分子生态结构发生不同程度改变,DM患者阴道真菌菌群紊乱程度与血糖控制情况关系密切.     

念珠菌血流感染临床与实验室特点分析

目的根据血培养真菌阳性标本,进行病原学与药敏试验分析,探讨念珠菌在血流感染中的临床和实验室特点。方法收集某院2012年6月至2018年9月的血培养结果为真菌的临床资料,对真菌种类、阳性报警时间(TTP)、标本送检科室、病原菌来源和氟康唑药敏试验结果进行分析。结果血培养分离出真菌共86株,非重复分离株为50株,44株为念珠菌属。排在前3位的念珠菌分别为白念珠菌18株(40.91%),近平滑念珠菌和光滑念珠菌各10株各占(22.73%);近平滑念珠菌TTP[(56.14±7.22)h]最长,热带念珠菌TTP[(19.36±1.24)h]最短,白念珠菌[(34.67±2.98)h]与光滑念珠菌[(38.16±4.12)h]TTP接近居中;念珠菌血症前3位科室为神经外科10株(22.73%)、肿瘤血液科6株(13.64%)、重症监护病房5株(11.36%);泌尿系统为最常见感染来源,其次为腹腔引流感染和导管相关感染;近平滑念珠菌、热带念珠菌对氟康唑敏感率均为100%,白念珠菌和光滑念珠菌分别为88.89%和70%,克柔酵母菌和酿酒酵母菌各1株为耐药和敏感。结论本院念珠菌血流感染最常见为白念珠菌,其次为近平滑念珠菌和光滑念珠菌。如果血培养需氧瓶阳性且TTP大于40 h,发生念珠菌血流感染的可能较大,临床或实验室应高度重视。泌尿系感染、导管相关血流感染、手术部位感染是念珠菌血症的重要感染源。大部分念珠菌对氟康唑仍敏感。     

基于ITS2高通量测序 研究强直性脊柱炎患者肠道真菌特征

目的探究强直性脊柱炎(ankylosing spondylitis,AS)患者肠道真菌菌群的多样性特征,分析健康人群与AS患者肠道真菌的结构差异。方法收集17例健康人群新鲜粪便样本和24例AS患者新鲜粪便样本,分别称为HC组和AS组,提取两组粪便样本总DNA;根据真菌ITS2区设计引物进行扩增,利用Illumina HiSeq PE250平台进行ITS2高通量测序;测序结果经过Reads拼接,OTUs(operational taxonomic units)聚类,Alpha和主成分分析,物种组成统计,显著性差异分析,最终得到样本物种信息。结果对肠道真菌菌群进行Alpha分析,各多样性指标中,shannon和observed_species指数差异有统计学意义(P0.05),其余指数差异均无统计学意义,故不能明确两组间多样性的差异。主成分分析提示差异显著。对肠道真菌结构进行分析,门的水平分析显示,担子菌门(Basidiomycota)在HC组和AS组中差异显著,接合菌门(Zygomycota)在两组间差异极显著;纲和属的水平分析显示,Ascomycota_unidentified纲在两组中差异显著,伞菌纲(Agaricomycetes)、Incertae_sedis_10纲、Orbiliomycetes纲差异极显著。Agaricomycetes_unidentified_1属、Amphinema属、Geoglossales_unidentified_1属、腔块菌属(Hydnotrya)差异显著,鹅膏菌属(Amanita)和锁瑚菌属(Clavulina)差异极显著。结论本实验证实了在AS患者中存在肠道真菌菌群失调,其特征是生物多样性和结构的改变,揭示肠道真菌也可能在AS发病中发挥作用。     

Candida Colonization in Urine Samples of ICU Patients: Determination of Etiology, Antifungal Susceptibility Testing and Evaluation of Associated Risk Factors

The presence of Candida in urine presents a therapeutic challenge for the physician as it is often asymptomatic, and management guidelines have not been clearly laid down on this issue. The presence of Candida in urine may represent contamination of clinical sample, actual colonization of the lower urinary tract or may be a true indicator of invasive infection of lower and/or upper urinary tract. In a clinical setting like the ICU, multiple risk factors for Candida colonization may be present in the same patient, thereby increasing the chances of candiduria, manifold. In the present study on 80 patients in ICU, high rate of Candida colonization (57.5%) was found in urine samples of ICU patients with C. tropicalis (57.3%) being the predominant species. We also isolated 8 strains of Trichosporon species, all of these presented as a mixed infection along with Candida species. Among the various risk factors studied, urinary catheterization and previous antibiotic therapy were identified as statistically significant (P value <0.05). The minimum inhibitory concentration of the isolates was determined for amphotericin B, fluconazole and itraconazole by E-test. Most of the isolates were susceptible to amphotericin B. The C. parapsilosis strains did not show any drug resistance; however, resistance to fluconazole was observed 18.6, 27.27, 50 and 25% in C. tropicalis, C. albicans, C. glabrata and Trichosporon species, respectively.     

Fecal microflora of Greek healthy neonates

This study aimed to explore, in our geographical region, the development of intestinal microflora and the colonization patterns of lactic acid bacteria and bifidobacteria during the first three months of life and to investigate the effect of the mode of delivery. Fecal specimens from 82 healthy, full-term infants were collected prospectively 4, 30 and 90 days after delivery and subcultured on nonselective and selective media. Identification of isolates was performed by microbiological and molecular methods. For the delivery effect, two groups of vaginally or caesarean-delivered exclusively breast-fed infants were studied. Despite the early high total counts of aerobes and anaerobes, colonization of lactobacilli and bifidobacteria was overall limited until 3 months of age. Furthermore, caesarean-delivered infants were less often colonized with lactobacilli at day 4 (4% vs. 59%, p = 0.000) and with bifidobacteria at day 4 (0% vs. 23%, p = 0.015) and 30 (0% vs. 35%, p = 0.042) compared to vaginally delivered ones. No bacterial populations differences were detected to compare colonized infants. Identification results indicated the predominance of Lactobacillus rhamnosus, Lactobacillus johnsonii and Lactobacillus paracasei species in neonatal gut microflora up to the first month of life and diversity of Lactobacillus species in vaginally delivered, colonized newborns, at fourth day. Furthermore, Bifidobacterium longum and Bifidobacterium breve were the most frequently detected Bifidobacterium species in vaginally delivered, breast-fed infants. In conclusion our study revealed a restricted colonization pattern of lactic acid bacteria in Greek infants and a delay in the development of Lactobacillus and Bifidobacterium spp. microbiota after caesarean section. Further analysis of potential consequences of these findings is required.     

Prevalence of oral lesions by Candida sp.: Their varieties and serotypes in a population of patients with AIDS under a highly active antiretroviral therapy.

The aim of this study has been to determine the prevalence of oral candidiasis and oral Candida carriers in an AIDS population under highly active antiretroviral therapy. Eighty-six AIDS patients treated with an antiretroviral combination (indinavir o ritonavir o saquinavir + zidovudine [AZT] + lamivudine [3TC]). Patients were grouped attending the predisposing factors for HIV infection in: intravenous drug users (IDU), heterosexuals, homosexuals, patients using hematological products or having unknown factors. Oral cavity was examined and an oral specimen was inoculated in a chromogenic culture medium (Albicans ID, bioMérieux, France). The prevalence of oral Candida lesions was 30.2% and Candida was isolated from 54.7% of patients. The predominant species was C. albicans serotype A in all the groups with the exception of homosexual patients, were C. albicans serotype B was the predominant. The IDU group showed the higher prevalence of Candida lesions and oral yeasts colonization, followed by the group of heterosexuals and homosexuals. An association was found between the presence of lesions and/or Candida spp. and the clinical stage or the viral concentration. The species Candida dubliniensis was isolated in the oral samples of two patients with candidosis and in two individuals without oral candidosis. The finding of this species in Spanish patients can be added to the data obtained in epidemiological studies in other countries.     

Isolation of fungi from bats of the Amazon basin

A total of 2,886 bats captured in the Amazon Basin of Brazil were processed for the isolation of fungi. From the livers, spleens, and lungs of 155 bats (5.4%), 186 fungal isolates of the genera Candida (123 isolates), Trichosporon (26 isolates), Torulopsis (25 isolates), Kluyveromyces (11 isolates), and Geotrichum (1 isolate) were recovered. Seven known pathogenic species were present: Candida parapsilosis, C. guilliermondii, C. albicans, C. stellatoidea, C. pseudotropicalis, Trichosporon beigelii, and Torulopsis glabrata. Twenty-three culture-positive bats showed identical fungal colonization in multiple organs or mixed colonization in a single organ. The fungal isolation rates for individual bat species varied from 1 fungus per 87 bats to 3 fungi per 13 bats, and the mycoflora diversity for members of an individual fungus-bearing bat species varied from 16 fungi per 40 bats to 7 fungi per 6 bats. Of the 38 fungal species isolated, 36 had not been previously described as in vivo bat isolates. Of the 27 culture-positive bat species, 21 had not been previously described as mammalian hosts for medically or nonmedically important fungi.     

Isolation of fungi from bats of the Amazon basin.

A total of 2,886 bats captured in the Amazon Basin of Brazil were processed for the isolation of fungi. From the livers, spleens, and lungs of 155 bats (5.4%), 186 fungal isolates of the genera Candida (123 isolates), Trichosporon (26 isolates), Torulopsis (25 isolates), Kluyveromyces (11 isolates), and Geotrichum (1 isolate) were recovered. Seven known pathogenic species were present: Candida parapsilosis, C. guilliermondii, C. albicans, C. stellatoidea, C. pseudotropicalis, Trichosporon beigelii, and Torulopsis glabrata. Twenty-three culture-positive bats showed identical fungal colonization in multiple organs or mixed colonization in a single organ. The fungal isolation rates for individual bat species varied from 1 fungus per 87 bats to 3 fungi per 13 bats, and the mycoflora diversity for members of an individual fungus-bearing bat species varied from 16 fungi per 40 bats to 7 fungi per 6 bats. Of the 38 fungal species isolated, 36 had not been previously described as in vivo bat isolates. Of the 27 culture-positive bat species, 21 had not been previously described as mammalian hosts for medically or nonmedically important fungi.     

The Yin and Yang of Bacterial Resilience in the Human Gut Microbiota

The human gut is home to trillions of microbes that form a symbiotic relationship with the human host. During health, the intestinal microbiota provides many benefits to the host and is generally resistant to colonization by new species; however, disruption of this complex community can lead to pathogen invasion, inflammation, and disease. Restoration and maintenance of a healthy gut microbiota composition requires effective therapies to reduce and prevent colonization of harmful bacteria (pathogens) while simultaneously promoting growth of beneficial bacteria (probiotics). Here we review the mechanisms by which the host modulates the gut community composition during health and disease, and we discuss prospects for antibiotic and probiotic therapy for restoration of a healthy intestinal community following disruption.     

老年住院患者口咽部念珠菌定植状况及菌种分布调查

目的调查老年住院患者口咽部念珠菌定植状况及菌种分布特点,为有效预防念珠菌感染提供参考。方法对解放军第44医院收治的894例住院患者口咽部念珠菌定植状态进行调查分析。结果894例住院患者口咽部标本共培养出念珠菌121株,念珠菌定植率为13．5％,老年患者的定植率高于非老年患者。念珠菌定植以白色念珠菌所占比例最大,占74．5％。年龄≥80岁、肺部基础疾病的存在及使用抗菌药物患者口咽部念珠菌定植率高于普通患者,两者比较差异有统计学意义（P〈0．05）。结论老年患者口咽部念珠菌定植率较高,菌种分布以白色念珠菌最为常见。念珠菌定植与患者年龄、肺部基础疾病的存在及抗菌药物使用情况密切相关。     

Study of acute vulvovaginitis in sexually active adult women, with special reference to candidosis, in patients of the Francisco J. Muñiz Infectious Diseases Hospital

The results of microbiological vaginal secretions samples obtained from 749 women (from July 2001 to July 2002) were studied in the Bacteriology Unit of the Francisco Javier Mu?iz Hospital from Buenos Aires. All patients suffered acute vulvovaginitis were child bearing and sexually active women, 334 of them were HIV-positive. The following are the results of the microbiological studies: Lactobacillus spp 50.6%, Gardnerella vaginalis 25.6%, Candida spp 17.4%, Trichomonas vaginalis 5.3%, Neisseria gonorrhoeae 0.3% and B group Streptococcus 0.8%. Candida vaginitis was significantly more frequent in HIV-positive patients, (21.6% vs 14%; p = 0.0086); meanwhile, trichomoniasis was less common although the difference was not statistically significant (3.6 vs 6.7%, p = 0.0810). The following Candida species were isolated in this study: Candida albicans 76.8%, Candida glabrata 15.6%, Candida parapsilosis 2.9%, Candida tropicalis 1.5% and Candida krusei 0.7%. Eight cases (6.2%) of vaginitis were produced by two Candida species (C. albicans and C. glabrata), and in three cases (2.17%) Saccharomyces cerevisiae were isolated. Five women suffering acute vaginitis with Candida spp presented another etiologic agent of vaginal infection, three cases T. vaginalis and two cases G. vaginalis. The following are some of the most important findings of this study: 1) Half of the patients presented a normal microbial biota; 2) Candida spp vaginitis was significantly more frequent among HIV-positive women; 3) we observed a high incidence of Candida glabrata infections (15.9%), 4) 6.2% of vaginal candidiasis were caused by more than one Candida species and, 5) the susceptibility pattern of C. albicans and C. glabrata isolates against fluconazole was similar to the one observed in other studies. The majority of C. albicans isolates were susceptible to fluconazole (MIC90 = 0.5 microg/ml) meanwhile C. glabrata strains were much less susceptible to this drug (MIC50 and MIC90 = 32 microg/ml).     

Effect of various antibiotics on gastrointestinal colonization and dissemination by Candida albicans

Mice were treated orally with various antibiotics to determine which members of the indigenous intestinal microflora normally suppress Candida albicans colonization and dissemination from the gastrointestinal (GI) tract. The mice were given penicillin, clindamycin, vancomycin, erythromycin, or gentamicin for 3 days, and then challenged orally with C. albicans. Penicillin, clindamycin, and vancomycin, but not gentamicin or erythromycin, decreased the total anaerobic bacterial populations in the animals ceca, and increased the enteric bacilli population levels. All three of the former antibiotics allowed C. albicans to proliferate in the gut and, subsequently, disseminate from the GI tract to visceral organs. The ability of C. albicans to associate with intestinal mucosal surfaces was also tested. It was found that antibiotics which reduced anaerobic population levels, but not enteric bacilli or aerobes, also predisposed animals to mucosal association by C. albicans. It is suggested that the strictly anaerobic bacterial populations which predominate in the gut ecosystem are responsible for the inhibition of C. albicans adhesion, colonization and dissemination from the GI tract.     

Detection of Candida antigen in bronchoalveolar lavage fluid

While bronchoalveolar lavage is frequently performed to evaluate immunocompromised hosts for infection, the significance of rare yeasts found on the cytologic examination of lavage fluid is unclear. This study used the latex agglutination method to test lavage fluids for Candida antigen to assess its usefulness in distinguishing Candida pneumonia from Candida colonization of the respiratory tract or oral contamination of the lavage specimen. Ninety-seven specimens from 87 patients were categorized on the basis of historical, microbiologic, cytologic and serologic data. Bronchoalveolar lavage fluids were positive for Candida antigen in 0 of 20 specimens from normal controls, 0 of 14 specimens from patient controls, 5 (36%) of 14 specimens from patients with Pneumocystis carinii pneumonia, 0 of 5 specimens from patients with gastrointestinal candidiasis, 0 of 9 specimens contaminated by oral-derived yeasts, 2 (10%) of 19 specimens from patients with probable Candida colonization and 15 (94%) of 16 specimens from patients with clinical and laboratory evidence of Candida pneumonia. We conclude that this test assists in the differentiation of Candida pneumonia from other situations in which yeasts are recovered by bronchoalveolar lavage.