快速识别最常见的念珠菌种，以指导早期抗真菌治疗.pdf

Rapid Identification Of The Most Common Candida Species To Guide Early Antifungal Therapy For Candidemia 快速识别最常见的念珠菌种，以指导早期抗真菌治疗 Dr. Fann Wu, Columbia University Medical Center New York, USA CANDIDEMIA 念珠菌血症 • 4th most common cause of hospital- associated bloodstream infections Incidence - 8 infections per 10,000 persons annually • Mortality 20-50% 死亡率 Often associated with disseminated disease Systemic as in septicemia, endocarditis and meningitis CANDIDEMIA • At risk populations 高危人群 ICU pts Prior colonization Central venous catheters Broad spectrum antibiotics Neutropenia (1000 neutrophils/µl) ETIOLOGICAL AGENTS • Candida albicans 白色念珠菌 • Candida glabrata 球拟酵母念珠菌 • Candida tropicalis 热带假丝酵母菌 • Candida krusei 克鲁斯假丝酵母菌 • Candida parapsilosis 近平滑假丝酵母菌 Early Identification Guides Rx • Rapid and accurate identification of the most common Candida species is essential to guide treatment. • The laboratory plays a critical role in helping the clinician develop antibiotic usage strategies. CANDIDEMIA CULTURE DX • Stains • KOH Gram • Periodic Acid-Schiff 过碘酸雪夫染色(PAS) • Culture Usually 1-5 Days To ID Non Selective Media -SAB Selective Media – Chromagar – Bird Seed Agar • ID Antifungal Susceptibility Microscan, API, Sensititer C. albicans on SAB MICROSCOPIC COLONIAL MORPH OVOID BLASTOCONIDIA POST-MORTEM ESOPHAGUS C. albicans Invasion of Blood Vessel Note blastoconidia pseudohyphae C. ALBICANS FLUCONAZOLE Etest DISK Test NEW