韩国非hiv患者隐球菌病的微生物学和临床流行病学：4年收集

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-26 DOI:10.1016/j.jiph.2025.102842

Bosung Park , Eunsang Suh , Yeseul Choi , Tae Yeul Kim , Eun Jeong Won , Hee Jae Huh , Heungsup Sung , Mi-Na Kim

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引用次数: 0

摘要

隐球菌病在世界范围内造成很高的疾病负担；然而，在韩国相对罕见，关于其患病率和临床特征的数据仍然有限。本研究旨在描述临床隐球菌分离物的微生物学特征，并调查韩国hiv阴性隐球菌病患者的临床概况。方法收集韩国两所大学附属医院（共约5000张病床）4年间的隐球菌临床分离株。进行物种鉴定、多位点序列分型和抗真菌药敏试验。采用单因素和多因素logistic回归分析隐球菌病的临床特征和影响30天死亡率的预后因素。结果39例患者共分离到40株非重复分离株，测序证实38株为新生C.， 2株为去尾C.。新形态C. neoformmans的MLST分析鉴定出35株菌株为ST5，还有ST2、ST15和一个新发现的序列型ST707。非野生型对两性霉素B、5-氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑和泊沙康唑的感染率分别为10.0 %、4.0 %、8.0 %、6.0 %、2.0 %和8.0 %。然而，这两个分离株对上述所有抗真菌药物均表现出野生型表型。总体而言，累计30天死亡率为41.0% %（16/39）。单因素分析显示，全肠外营养、严重脓毒症、入住重症监护病房、使用血管加压药、急性肾功能衰竭和潜在慢性肾脏疾病（CKD）是导致30天死亡率的危险因素，而唑治疗是保护因素。最后，通过多因素分析，CKD是30天死亡率的独立危险因素。在不同序列类型的分离株中，患者存活率无显著差异。结论韩国新生隐球菌的主要基因型为ST5， CKD显著增加隐球菌病30天死亡率。

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Microbiological and clinical epidemiology of cryptococcosis in non-HIV Korean patients: 4-year collection

Background

Cryptococcosis causes a high burden of disease worldwide; however, it has been relatively rare in Korea, where data on its prevalence and clinical characteristics remain limited. This study aimed to characterize the microbiological features of clinical cryptococcal isolates and to investigate the clinical profiles of HIV-negative patients with cryptococcosis in South Korea.

Methods

Clinical isolates of Cryptococcus species were collected from two university hospitals in South Korea (about 5000 beds, in total) over a 4-year period. Species identification, multilocus sequence typing, and antifungal susceptibility testing were performed. Clinical features of cryptococcosis and prognostic factors for 30-day mortality were analyzed by univariate and multivariate logistic regression analysis.

Results

A total of 40 nonduplicate isolates from 39 patients during the study period and sequencing confirmed 38 isolates of C. neoformans and 2 isolates of C. deuterogatii. MLST analysis of C. neoformans identified 35 isolates as ST5, along with single isolates of ST2, ST15, and a newly discovered sequence type, ST707. The percentages of non-wild type to amphotericin B, 5-fluorocytosine, fluconazole, itraconazole, voriconazole, and posaconazole were 10.0 %, 4.0 %, 8.0 %, 6.0 %, 2.0 %, and 8.0 %, respectively. However, the two isolates of C. deuterogatii exhibited a wild type phenotype for all the aforementioned antifungal agents. Overall, the cumulative 30-day mortality rate was 41.0 % (16/39). Univariate analysis showed that total parenteral nutrition, severe sepsis, intensive care unit admission, vasopressor use, acute renal failure, and underlying chronic kidney disease (CKD) were risk factors for 30-day mortality, and azole therapy was the protective factor. Finally, CKD was the independent risk factor for 30-day mortality by multivariate analysis. No significant differences were observed in patient survival across sequence type of isolates.

Conclusions

This study showed that ST5 was the predominant genotype of C. neoformans in South Korea and CKD significantly increased the risk of 30-day mortality of cryptococcosis.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.