2018—2022年华东地区临床分离念珠菌耐药性监测  

Surveillance of antifungal resistance in clinical isolates of Candida spp.in East China Invasive Fungal Infection Group from 2018 to 2022

作　　者：王东江 吴文娟[1] 郭建[1] 张旻 林慧萍 万菲菲 马晓波[2] 李玥婷 李佳[4] 贾慧琼 曾令兵[6] 鹿秀海 金炎[8] 蔡金凤[9] 李伟[10] 白志敏[11] 吴永琴 丁卉[13] 廖忠先 李根 张慧 孟红委 邓嫦姿 陈峰[19] 蒋娜 秦洁 董郭平 张静华[23] 奚卫 张灏旻[25] 汤荣[26] 李丽[27] 王苏珍 潘芬[29] 高晶[30] 江露 房华[32] 李志兰[33] 袁轶群[34] 汪国庆 王院霞 王立平 WANG Dongjiang;WU Wenjuan;GUO Jian;ZHANG Min;LIN Huiping;WAN Feifei;MA Xiaobo;LI Yueting;LI Jia;JIA Huiqiong;ZENG Lingbing;LU Xiuhai;JIN Yan;CAI Jinfeng;LI Wei;BAI Zhimin;WU Yongqin;DING Hui;LIAO Zhongxian;LI Gen;ZHANG Hui;MENG Hongwei;DENG Changzi;CHEN Feng;JIANG Na;QIN Jie;DONG Guoping;ZHANG Jinghua;XI Wei;ZHANG Haomin;TANG Rong;LI Li;WANG Suzhen;PAN Fen;GAO Jing;JIANG Lu;FANG Hua;LI Zhilan;YUAN Yiqun;WANG Guoqing;WANG Yuanxia;WANG Liping(Department of Laboratory Medicine,South Division Shanghai East Hospital Affiliated to Tongji University,Shanghai 200123,China)

机构地区：[1]上海市东方医院南院,同济大学附属东方医院南检验科,上海200123 [2]厦门大学附属第一医院 [3]江西省人民医院 [4]南京鼓楼医院 [5]浙江大学医学院附属第一医院之江院区 [6]南昌大学第一附属医院 [7]山东省眼科医院 [8]山东省立医院 [9]上海市公共卫生临床中心 [10]山东大学齐鲁医院 [11]福建省晋江市医院 [12]安徽省立医院 [13]丽水市中心医院 [14]福建医科大学附属协和医院 [15]上海市东方医院 [16]上海市第五人民医院 [17]上海市胸科医院 [18]上海长海医院 [19]上海交通大学医学院附属新华医院 [20]上海市浦东新区公利医院 [21]复旦大学附属儿科医院 [22]海军军医大学第三附属医院 [23]上海市第十人民医院 [24]上海交通大学医学院附属仁济医院(南院区) [25]上海交通大学医学院附属仁济医院 [26]上海市第一人民医院(北部) [27]上海交通大学医学院附属瑞金医院北部院区 [28]复旦大学附属中山医院 [29]上海市儿童医院 [30]复旦大学附属妇产科医院 [31]上海市中西医结合医院 [32]上海市浦东新区人民医院 [33]上海市第七人民医院 [34]复旦大学附属金山医院 [35]上海市嘉定区中心医院 [36]上海交通大学医学院附属第九人民医院 [37]上海交通大学医学院附属同仁医院

出　　处：《中国感染与化疗杂志》2024年第4期402-409,共8页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81971990;82172326)。

摘　　要：目的监测中国华东地区临床分离念珠菌的耐药性,为临床诊断和治疗提供参考。方法以质谱或分子的方法对2018年1月—2022年12月收集的菌株进行复核鉴定,采用肉汤微量稀释法进行10种抗真菌药物的药敏试验。依据2022年美国临床和实验室标准化协会(CLSI)M27 M44s-Ed3和M57s-Ed4对药敏试验结果进行判读。结果共收集念珠菌3026株,无菌部位分离菌株占65.33%,主要标本类型为血液38.86%和胸腹水10.21%。白念珠菌占比(44.51%)最高、其次为近平滑念珠菌复合群19.46%、热带念珠菌13.98%、光滑念珠菌10.34%和其他念珠菌0.79%。对测试的10种抗真菌药物:白念珠菌较为敏感,敏感率最低为93.62%,2.97%的菌株对氟康唑剂量依赖性敏感(SDD);近平滑念珠菌对氟康唑SDD为2.61%,耐药率为9.42%,对其他药物的敏感率均大于90%;光滑念珠菌对氟康唑SDD为92.01%,耐药率为7.99%,泊沙康唑、伏立康唑非野生型菌株(NWT)分别为32.27%、48.24%,其他药物的敏感率均大于90%;热带念珠菌对氟康唑、伏立康唑耐药率分别为29.55%、26.24%,对泊沙康唑、伊曲康唑NWT分别为76.60%、21.99%,对棘白菌素类药物耐药率为2.36%。结论华东地区念珠菌的分离率和菌种分布与国内外报道基本一致,近平滑念珠菌复合群对氟康唑有一定的耐药性,热带念珠菌对三唑类药物有较高的耐药性,光滑念珠菌对氟康唑非敏感率较高。白念珠菌、近平滑念珠菌、热带念珠菌和光滑念珠菌均出现了对棘白菌素类耐药菌株。Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3026 strains of Candida were collected,65.33%of which were isolated from sterile body sites,mainly from blood(38.86%)and pleural effusion/ascites(10.21%).The predominant species of Candida were Candida albicans(44.51%),followed by Candida parapsilosis complex(19.46%),Candida tropicalis(13.98%),Candida glabrata(10.34%),and other Candida species(0.79%).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62%).Only 2.97%of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61%and a resistance rate of 9.42%to fluconazole,and susceptibility rates above 90%to other drugs.Candida glabrata had a SDD rate of 92.01%and a resistance rate of 7.99%to fluconazole,resistance rates of 32.27%and 48.24%to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90%to other drugs.Candida tropicalis had resistance rates of 29.55%and 26.24%to fluconazole and voriconazole,respectively,resistance rates of 76.60%and 21.99%to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36%to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerg

关 键 词：真菌耐药性监测 念珠菌 侵袭性真菌感染 药物敏感性试验 抗真菌药物 

分 类 号：R379.4[医药卫生—病原生物学]