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

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。

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

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 invasive yeast in China should be strengthened continuously,and the dosage of antibacterial drugs should be controlled reasonably to prevent the increase of drug resistance.