中国侵袭性真菌耐药监测网成员单位重症监护室侵袭性酵母的分布特征及其对唑类药物敏感性的变迁

目的回顾性分析2010-2014年中国侵袭性真菌耐药监测网(CHIF-NET)62所监测中心重症监护室(ICU)侵袭性酵母的现状,了解我国侵袭性酵母分布的特征及其对唑类药物的耐药情况。方法收集各所监测中心初步鉴定的菌株,送至北京协和医院检验科,采用基质辅助激光解吸电离飞行时间质谱技术结合分子测序技术对所有菌株进行复核鉴定,再进行唑类药物敏感性检测。结果2010-2014年,62所监测中心ICU共检出侵袭性酵母2863株,其中以念珠菌属最多,计2771株。标本类型包括血液标本(50.8%,1453/2863),无菌体液标本(49.2%,1410/2863);其中,50.7%(1404/2771)的念珠菌属分离自血液标本。5年间,白念珠菌对氟康唑和伏立康唑十分敏感,敏感率>99.0%;热带念珠菌对氟康唑和伏立康唑的耐药率显著升高,均从12.2%升至23.1%(P<0.01);光滑念珠菌对氟康唑的耐药率也显著升高,从14.7%升至27.7%(P<0.01)。非念珠菌属中,新型隐球菌复合体对伏立康唑全部敏感,从2013年开始出现对氟康唑耐药菌;其他酵母对两种唑类药物耐药率整体较高,分别为43.6%和32.7%。菌株复核鉴定的正确率为86.2%(2467/2863)。结论ICU中侵袭性酵母分离株中以念珠菌属为主,主要分离自血液,氟康唑和伏立康唑对其抗菌作用非常显著;而非白念珠菌的耐药率有不同程度的升高及交叉耐药的出现,临床需要加以重视。

A retrospective analysis of invasive yeast strains in China Hospital Invasive Fungal Surveillance Net from 2010 to 2014:changing pattern of species distribution and azoles susceptibility

Objective A retrospective analysis was conducted to examine the invasive yeast strains in China Hospital Invasive Fungal Surveillance Net(CHIF-NET)covering 62 intensive care units(ICUs)from 2010 to 2014 for better understanding the distributin of the invasive yeast strains and azoles susceptibility.Methods Invasive yeast isolates collected from each hospital were preliminarily screened and identified.All isolates were re-examined and identified at the Department of Clinical Laboratory,Peking Union Medical College Hospital,by using matrix-assisted laser desorption/ionization-time of flight mass spectrometry(MALDITOF MS)combined with molecular sequencing.The strains were tested for their susceptibility to azoles.Results Overall,2863 invasive yeast strains were collected from 62 ICUs across China between 2010 and 2014,of which Candida species accounted for the most part(96.8%,2771/2863).The fungal strains were mainly isolated from blood samples(50.8%,1453/2863)and aseptic body fluid specimens(49.2%,1410/2863).About half(50.7%,1404/2771)of the Candida strains were isolated from blood samples.Over the five years,fluconazole and voriconazole exhibited excellent activity against C.albicans isolates,more than 99.0%of which were susceptible to fluconazole and voriconazole.C.tropicalis showed significantly increased resistance rate to the two azoles,both from 12.2%to 23.1%(P<0.01).C.glabrata also exhibited significantly increased fluconazole resistance from 14.7%to 27.7%(P<0.01).All Cryptococcus neoformans complexes were susceptible to voriconazole,but fluconazole-resistant strains emerged since 2013.Other fungal species overall had higher resistance rate to both fluconazole(43.6%resistant)and voriconazole(32.7%resistant).The preliminary identification result was confirmed by reexamination in 86.2%(2467/2863)of the fungal isolates.Conclusions Candida spp.was the most common invasive yeast species in ICU across China from 2010 to 2014,mainly isolated from blood samples.Over the five years,C.albicans was the most common invasive Candida isolates,showing excellent susceptibility to fluconazole and voriconazole.However,clinicians should pay more attention to other non-albicans Candida species,which exhibited higher azoles resistance and cross resistance.