Pfaller M A, Diekema D J, Jones R N, Messer S A, Hollis R J
Department of Pathology, University of Iowa College of Medicine and College of Public Health, Iowa City, Iowa 52242, USA.
J Clin Microbiol. 2002 Mar;40(3):852-6. doi: 10.1128/JCM.40.3.852-856.2002.
From 1 January 1997 through 31 December 2000, 2,047 bloodstream infections (BSIs) due to Candida spp. were reported from hospitals in the United States, Canada, Latin America, and Europe participating in the SENTRY Antifungal Surveillance Program. Among individuals in four age groups (< or =1, 2 to 15, 16 to 64, and > or =65 years) Candida albicans was the most common species, causing 60, 55, 55, and 50% of infections, respectively. C. glabrata caused 17 to 23% of BSIs in those ages 16 to 64 and > or = 65 years, whereas it caused only 3% of BSIs in the individuals in the two younger age groups (P < 0.001). C. parapsilosis (which caused 21 to 24% of BSIs) and C. tropicalis (which caused 7 to 10% of BSIs) were more common than C. glabrata in individuals ages < or =1 year and 2 to 15 years. Isolates of Candida spp. showed a trend of decreasing susceptibility to fluconazole, itraconazole, and amphotericin B with increasing patient age (P < or = 0.01). None of the C. glabrata isolates from individuals < or =1 year old were resistant to fluconazole, whereas they made up 5 to 9% of isolates from individuals ages 16 to 64 and > or =65 years. Isolates of C. tropicalis from patients < or =1 year old were more susceptible to flucytosine (MIC at which 90% of isolates are inhibited [MIC(90)], 0.5 microg/ml; 0% resistant isolates) than those from patients > or =65 years old (MIC(90), 32 microg/ml; 11% resistant isolates). The investigational triazoles posaconazole, ravuconazole, and voriconazole were all highly active against all species of Candida from individuals in all age groups. These data demonstrate differences in the species distributions of pathogens and differences in antifungal resistance among isolates from individuals in the pediatric and adult age groups. Ongoing surveillance will enhance efforts to limit the extent of antifungal resistance in individuals in various age groups.
1997年1月1日至2000年12月31日,参与哨兵抗真菌监测项目的美国、加拿大、拉丁美洲和欧洲的医院报告了2047例念珠菌属引起的血流感染(BSIs)。在四个年龄组(≤1岁、2至15岁、16至64岁和≥65岁)的个体中,白色念珠菌是最常见的菌种,分别导致60%、55%、55%和50%的感染。光滑念珠菌在16至64岁和≥65岁的人群中引起17%至23%的血流感染,而在两个较年轻年龄组的个体中仅引起3%的血流感染(P<0.001)。近平滑念珠菌(引起21%至24%的血流感染)和热带念珠菌(引起7%至10%的血流感染)在≤1岁和2至15岁的个体中比光滑念珠菌更常见。念珠菌属分离株对氟康唑、伊曲康唑和两性霉素B的敏感性呈现随患者年龄增加而降低的趋势(P≤0.01)。≤1岁个体的光滑念珠菌分离株中无一株对氟康唑耐药,而在16至64岁和≥65岁个体的分离株中,这一比例为5%至9%。≤1岁患者的热带念珠菌分离株比≥65岁患者的分离株对氟胞嘧啶更敏感(90%分离株被抑制的最低抑菌浓度[MIC(90)],0.5μg/ml;耐药分离株为0%)(MIC(90),32μg/ml;耐药分离株为11%)。研究用三唑类药物泊沙康唑、雷夫康唑和伏立康唑对所有年龄组个体的所有念珠菌种均具有高活性。这些数据表明,儿科和成人年龄组个体的病原体菌种分布存在差异,分离株的抗真菌耐药性也存在差异。持续监测将加强限制不同年龄组个体抗真菌耐药性程度的工作。