2013年中国侵袭性酵母菌感染流行病学和唑类药物耐药性分析  

Epidemiology and analysis of azole drug resistance of yeast isolates causing invasive infections in China in 2013

作　　者：王瞳[1,2] 于淑颖 肖盟 张戈[1,2] 张京家 段思蒙[1,2] 康巍 张延海 赵颖 张丽 王贺 徐英春[1,2] WANG Tong;YU Shuying;XIAO Meng;ZHANG Ge;ZHANG Jingjia;DUAN Simeng;KANG Wei;ZHANG Yanhai;ZHAO Ying;ZHANG Li;WANG He;XU Yingchun(Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing 100730, China;Beijing Key Laboratory of Mechanism Research and Accurate Diagnosis of Invasive Mycosis, Beijing 100730, China;Central Laboratory of Hebei Yanda Hospital, Langfang, Hebei 065200, China)

机构地区：[1]中国医学科学院北京协和医院检验科,北京100730 [2]侵袭性真菌病机制研究与精准诊断北京市重点实验室,北京100730 [3]河北燕达医院中心实验室,廊坊065200

出　　处：《中国真菌学杂志》2022年第1期32-37,共6页Chinese Journal of Mycology

基　　金：北京协和医学院2020年“中央高校基本科研业务费”(3332020005)。

摘　　要：目的通过对中国侵袭性真菌监测网(CHIF-NET)2013年中国48家综合医院收集的1 562株酵母菌进行流行病学分布及唑类耐药性分析,为临床侵袭性酵母菌的唑类用药提供数据基础。方法收集2013年中国侵袭性真菌监测网48家医院共1 562株酵母菌菌株及其原始信息,采用基质辅助激光解析电离飞行时间质谱(MALDI-TO MS,法国生物梅里埃公司)结合核糖体DNA测序明确菌种鉴定;根据美国临床实验室标准化协会(CLSI)M44-A2纸片扩散法检测菌株对氟康唑及伏立康唑的敏感性。结果本研究共分离出酵母菌1 562株,其中白念珠菌分离率最高(38.4%),其次为近平滑念珠菌复合体(18.4%)、热带念珠菌(16.4%)、光滑念珠菌复合体(9.4%)及其他少见菌种(<6.4%);患者性别中男性占比(60.7%)高于女性(38.9%);患者年龄中,65岁以上年龄段患者最多(34.2%),其次为50~65岁(30.6%)、15~49岁(29.9%)和0~14岁患者(<1.9%);标本来源中以血液标本(46.4%)为主,其次为腹水(10.2%)、导管(9.2%)及引流液(8.5%)、分泌物(5.2%),其他标本类型均较少(<4.7%)。住院患者分离率(93%)显著高于门急诊患者(7%);科室类型中以外科患者(33.8%)为主,其次为重症监护病房(ICU)患者(27.5%)、内科患者(20.5%)及其他病房(<18.2%);药敏结果显示,白念珠菌及近平滑念珠菌复合体对氟康唑及伏立康唑敏感性均较高(>94%),热带念珠菌对氟康唑及伏立康交叉耐药率最高(21.9%),光滑念珠菌复合体交叉耐药率次之(15%),其次为季也蒙念珠菌(8.1%)和菌膜念珠菌(4.3%)。结论应持续加强中国地区侵袭性酵母菌监测,在使用抗菌药物过程中,合理控制其用量,防止耐药率的上升。Objective By analyze the epidemiological distribution and azole resistance of 1562 strains of yeast collected from 48 general hospitals in China by CHIF-NET in 2013,so as to provide the data basis for the azole drugs use in clinical invasive yeast.Methods A total of 1562 yeast strains and their original information were collected from 48 hospitals of China's invasive fungal surveillance network in 2013.The strains were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometer(MALDI-TO MS,Biomerieux,France)and ribosomal DNA sequencing.The susceptibility of the strains to fluconazole and voriconazole was determined by CLSI M44-A2 disc-diffusion method.Results A total of 1562 yeast strains were isolated in this study.Candida albicans had the highest isolation rate(38.4%),followed by Candida parapsilosis complex(18.4%),Candida tropicalis complex(16.4%),Candida glabrata complex(9.4%)and other rare strains(<6.4%).The separation rate of male(60.7%)was higher than that of female(38.9%).The patients aged over 65 years were the most(34.2%),followed by the patients aged 50-65 years(30.6%),15-49 years(29.9%)and 0-14 years(<1.9%).Blood samples(46.4%)were the main source of samples,followed by ascites(10.2%),catheter(9.2%),drainage fluid(8.5%)and secretion(5.2%),and other types of samples were less(<4.7%).The separation rate of inpatients(93%)was significantly higher than that of outpatient and emergency patients(7%).Among the types of departments,surgical patients(33.8%)were the main,followed by intensive care unit ICU patients(27.5%),internal medicine patients(20.5%)and other wards(<18.2%).Drug susceptibility results showed that C.albicans and C.parapsilosis complex sensitivity to fluconazole and voriconazole were higher(>94%).C.tropicalis showed the highest(21.9%)cross-resistance to fluconazole and voriconazole,C.parapsilosis complex took second place of such cross-resistance(15%),Candida guilliermondii(8.1%)and Candida pelliculosa(4.3%)ranked third and fourth.Conclusion The surveillance of

关 键 词：酵母菌 分布 耐药率 

分 类 号：R519[医药卫生—内科学]