来自血液及其他通常无菌部位的442株念珠菌分离株的流行情况及抗真菌药敏性：加拿大魁北克一项为期两年（1996年至1998年）的多中心监测研究结果
Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: results of a 2-year (1996 to 1998) multicenter surveillance study in Quebec, Canada.
作者信息
St-Germain G, Laverdière M, Pelletier R, Bourgault A M, Libman M, Lemieux C, Noël G
机构信息
Laboratoire de Santé Publique du Québec, Institut National de Santé Publique, 20045 Chemin Sainte-Marie, Sainte-Anne-de-Bellevue, Québec H9X 3R5, Canada.
出版信息
J Clin Microbiol. 2001 Mar;39(3):949-53. doi: 10.1128/JCM.39.3.949-953.2001.
During a 2-year surveillance program (1996 to 1998) in Quebec, Canada, 442 strains of Candida species were isolated from 415 patients in 51 hospitals. The distribution of species was as follows: Candida albicans, 54%; C. glabrata, 15%; C. parapsilosis, 12%; C. tropicalis, 9%; C. lusitaniae, 3%; C. krusei, 3%; and Candida spp., 3%. These data, compared to those of a 1985 survey, indicate variations in species distribution, with the proportions of C. glabrata and C. parapsilosis increasing by 9 and 4%, respectively, and those of C. albicans and C. tropicalis decreasing by 10 and 7%, respectively. However, these differences are statistically significant for C. glabrata and C. tropicalis only. MICs of amphotericin B were > or =4 microg/ml for 3% of isolates, all of which were non-C. albicans species. Three percent of C. albicans isolates were resistant to flucytosine (> or =32 microg/ml). Resistance to itraconazole (> or =1 microg/ml) and fluconazole (> or =64 microg/ml) was observed, respectively, in 1 and 1% of C. albicans, 14 and 9% of C. glabrata, 5 and 0% of C. tropicalis, and 0% of C. parapsilosis and C. lusitaniae isolates. Clinical data were obtained for 343 patients. The overall crude mortality rate was 38%, reflecting the multiple serious underlying illnesses found in these patients. Bloodstream infections were documented for 249 patients (73%). Overall, systemic triazoles had been administered to 10% of patients before the onset of candidiasis. The frequency of isolation of non-C. albicans species was significantly higher in this group of patients. Overall, only two C. albicans isolates were found to be resistant to fluconazole. These were obtained from an AIDS patient and a leukemia patient, both of whom had a history of previous exposure to fluconazole. At present, it appears that resistance to fluconazole in Quebec is rare and is restricted to patients with prior prolonged azole treatment.
在加拿大魁北克省开展的一项为期2年（1996年至1998年）的监测项目中，从51家医院的415名患者身上分离出442株念珠菌。菌种分布如下：白色念珠菌占54%；光滑念珠菌占15%；近平滑念珠菌占12%；热带念珠菌占9%；葡萄牙念珠菌占3%；克柔念珠菌占3%；其他念珠菌属占3%。与1985年的一项调查数据相比，这些数据表明菌种分布存在变化，光滑念珠菌和近平滑念珠菌的比例分别增加了9%和4%，而白色念珠菌和热带念珠菌的比例分别下降了10%和7%。然而，只有光滑念珠菌和热带念珠菌的这些差异具有统计学意义。3%的分离株两性霉素B的最低抑菌浓度（MIC）≥4μg/ml，所有这些分离株均为非白色念珠菌菌种。3%的白色念珠菌分离株对氟胞嘧啶耐药（≥32μg/ml）。白色念珠菌、光滑念珠菌、热带念珠菌、近平滑念珠菌和葡萄牙念珠菌分离株对伊曲康唑（≥1μg/ml）和氟康唑（≥64μg/ml）的耐药率分别为1%、14%、5%、0%和0%。获取了343名患者的临床数据。总体粗死亡率为38%，反映出这些患者存在多种严重基础疾病。249名患者（73%）有血流感染记录。总体而言，在念珠菌病发病前，10%的患者已接受全身性三唑类药物治疗。在这组患者中，非白色念珠菌菌种的分离频率显著更高。总体而言，仅发现两株白色念珠菌分离株对氟康唑耐药。这两株分离株分别来自一名艾滋病患者和一名白血病患者，两人均有先前接触氟康唑的病史。目前，在魁北克，对氟康唑的耐药似乎很少见，且仅限于先前长期接受唑类治疗的患者。
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