| Objective: To analyze the clinical characteristics of patients with Aspergillus fumigatus infection and colonization,and explore the diagnostic value of the second generation sequencing of macrogenome in distinguishing Aspergillus fumigatus infection and colonization,so as to provide a theoretical basis for clinicians to identify Aspergillus fumigatus infection in the early stage,treat it in the early stage,and improve the prognosis of patients.Methods: In this paper,88 cases of Aspergillus fumigatus were selected from the inpatients of the First Affiliated Hospital of China Medical University from January 2020 to December 2022.First,they were divided into infection group and colonization group.Through collecting their clinical data,the differences between the clinical characteristics of infection group and colonization group were analyzed;Secondly,the infected patients were divided into survival group and death group,and the risk factors of Aspergillus fumigatus infection and death were analyzed by single factor analysis;Thirdly,the drug sensitivity of some strains of Aspergillus fumigatus in our hospital was observed by Yeast One in vitro drug sensitivity test;Fourth,the application value of m NGS in the identification of Aspergillus fumigatus infection and colonization was discussed by analyzing the results of m NGS.Results: 1.Among the 88 cases collected,the respiratory and critical medicine department and the critical medicine department have the most patients,and male patients are more than female patients.The average age of patients in the infection group is 63.82 years old,and the average age of patients in the colonization group is 65.63 years old.The number of patients in the infection group suffering from basic diseases is more.The lung CT of the patient showed polymorphism,without halo sign and air crescent sign.2.Univariate risk factor analysis was carried out between patients in the infection group and those in the colonization group.Compared with those in the colonization group,there were five factors in the infection group,including basic disease of organ transplantation,dyspnea,hypoproteinemia,NE% and CRP increase,p<0.05,with statistical significance;Patients with bronchial asthma,hypoproteinemia,leukopenia or deficiency in the course of disease,and NE% increase in infection survival and death(p<0.05);The use of glycopeptides,sulfonamides,oxazolamines,antiviral drugs,triazoles,AMB,echinocandins in the history of antibiotic use has a statistically significant p value of<0.05 in infection survival and infection death.3.In vitro drug sensitivity tests of some strains suggested that Aspergillus fumigatus was resistant to echinocandins.4.Ten people in the infected group were sent for m NGS testing,including 9 cases of Aspergillus fumigatus,1 case of Aspergillus tubingen,5 people in the colonization group were sent for m NGS test,and 2 cases were reported to Aspergillus fumigatus.Conclusion: The Department of Respiratory and Critical Care Medicine and the Department of Critical Care Medicine are the departments with a high incidence of Aspergillus fumigis infection,and the average age of infected patients is older and the underlying disease is more.GM tests have a higher degree of specificity and positive predictive value for determining Aspergillus fumigis infection and colonization.Patients who have had a previous organ transplant,dyspnea with clinical manifestations,hypoproteinemia during treatment,and elevated NE% and CRP are more susceptible to Aspergillus fumigatus infection.Hypoproteinemia and leukopenia or deficiency during treatment are independent risk factors for death.In vitro susceptibility testing of Aspergillus fumigatus strains showed that all of these strains were sensitive to voriconazole,and some strains were resistant to echinocandins.The detection results of m NGS were consistent with clinical diagnosis and had positive significance for the early diagnosis of Aspergillus fumigatus infection. |
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