背景:耳念珠菌是一种新兴的病原体和人类健康威胁。然而,由C.auris引起的真菌感染的诊断和治疗具有挑战性。
目的:这篇叙述性综述为急诊临床医生提供了一个重点概述。
结论:C.auris于2009年首次被发现,目前存在于除南极洲以外的所有大陆。金黄色葡萄球菌具有多种遗传因素导致抗菌素耐药性,在宿主内增加毒力和存活,和环境适应。它很容易在人与人之间传播,也很容易从环境传播给人,导致殖民。感染可能在定植后几天到几个月发展,最常见的是那些免疫受损的人,重大合并症或其他潜在疾病,医疗保健曝光,和最近的抗菌治疗。念珠菌,设备感染(例如,中心静脉导管),软组织或伤口感染,烧伤感染,骨髓炎,心肌炎,脑膜炎,尿路感染与金黄色葡萄球菌有关。应从可疑感染部位获取样品进行微生物培养。具有参考数据库的基质辅助激光解吸/电离飞行时间质谱(MALDI-TOFMS)是诊断的最佳方法。尽管其他分子测试方法是可用的。由于抗真菌耐药性,治疗具有挑战性,对氟康唑有90%以上的耐药性。棘球白素是最常用的一线治疗。预防定植和感染至关重要,包括在高危人群中进行筛查,并严格遵守预防感染的做法,采取接触预防措施和手部卫生,以及对患者区域的适当净化。
结论:了解金黄色葡萄球菌可以帮助急诊临床医生护理感染或定植的患者。
BACKGROUND: Candida auris is an emerging pathogen and human health threat. However, diagnosis and treatment of fungal infection due to C. auris are challenging.
OBJECTIVE: This narrative review provides a focused overview of C. auris for the emergency clinician.
CONCLUSIONS: C. auris was first identified in 2009 and is currently present on all continents except Antarctica. C. auris possesses multiple genetic factors resulting in antimicrobial resistance, increased virulence and survival within the host, and environmental adaptation. It is readily transmitted from person to person and from the environment to a person, resulting in colonization. Infection may develop days to months following colonization, most commonly in those with immunocompromised state, significant comorbidities or other underlying conditions, healthcare exposure, and recent antimicrobial therapy. Candidemia, device infection (e.g., central venous catheter), soft tissue or wound infection, burn infection, osteomyelitis, myocarditis, meningitis, and urinary tract infection have been associated with C. auris. Samples should be obtained from the suspected site of infection for microbiological culture. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with reference databases to differentiate C. auris from other species is optimal for diagnosis, though other molecular testing methods are available. Treatment is challenging due to antifungal resistance, with over 90% resistant to fluconazole. Echinocandins are most commonly used as the first line therapy. Prevention of colonization and infection are vital and include screening in high-risk populations and strict adherence to infection prevention practices with contact precautions and hand hygiene, as well as appropriate decontamination of patient areas.
CONCLUSIONS: An understanding of C. auris can assist emergency clinicians in the care of infected or colonized patients.