Pfaller M A, Diekema D J
Department of Pathology, Roy J. and Lucille A. Carver College of Medicine and College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
Clin Microbiol Infect. 2004 Mar;10 Suppl 1:11-23. doi: 10.1111/j.1470-9465.2004.t01-1-00844.x.
We determined the species distribution and in-vitro susceptibility of 6082 bloodstream infection (BSI) isolates of Candida spp. collected from 250 medical centres in 32 nations over a 10-year period from 1992 through 2001. The species included 3401 C. albicans, 984 C. glabrata, 796 C. parapsilosis, 585 C. tropicalis, 153 C. krusei, 67 C. lusitaniae, 48 C. guilliermondii, 10 C. famata, 10 C. kefyr, six C. pelliculosa, five C. rugosa, four C. lipolytica, three C. dubliniensis, three C. inconspicua, two C. sake and one isolate each of C. lambica, C. norvegensis and C. zeylanoides. Minimum inhibitory concentration determinations were made using the National Committee for Clinical Laboratory Standards reference broth microdilution method. Variation in the rank order and frequency of the different species of Candida was observed over time and by geographic area. The proportion of BSI due to C. albicans and C. glabrata increased and C. parapsilosis decreased over time in Canada, the USA and Europe. C. glabrata was an infrequent cause of BSI in Latin America and the Asia-Pacific region. Very little variation in fluconazole susceptibility was observed among isolates of C. albicans, C. tropicalis and C. parapsilosis. These species accounted for 78% of all BSI and remained highly susceptible (91-100% susceptible) to fluconazole from 1992 to 2001 irrespective of geographic origin. The prevalence of fluconazole resistance among C. glabrata isolates was variable both over time and among the various countries and regions. Resistance to fluconazole among C. glabrata isolates was greatest in the USA and varied by US census region (range 0-23%). These observations are generally encouraging relative to the sustained usefulness of fluconazole as a systemically active antifungal agent for the treatment of candida BSI.
我们确定了1992年至2001年这10年间从32个国家的250个医疗中心收集的6082株念珠菌属血流感染（BSI）分离株的菌种分布及体外药敏情况。这些菌种包括3401株白色念珠菌、984株光滑念珠菌、796株近平滑念珠菌、585株热带念珠菌、153株克柔念珠菌、67株葡萄牙念珠菌、48株季也蒙念珠菌、10株法塔念珠菌、10株解脂念珠菌、6株薄膜念珠菌、5株皱落念珠菌、4株解脂念珠菌、3株都柏林念珠菌、3株 inconspicua念珠菌、2株清酒念珠菌以及各1株兰比念珠菌、挪威念珠菌和锡兰念珠菌。采用美国国家临床实验室标准委员会参考肉汤微量稀释法测定最低抑菌浓度。观察到不同念珠菌种的排名顺序和频率随时间及地理区域有所变化。在加拿大、美国和欧洲，由白色念珠菌和光滑念珠菌引起的BSI比例随时间增加，而近平滑念珠菌引起的BSI比例下降。光滑念珠菌在拉丁美洲和亚太地区是BSI的罕见病因。在白色念珠菌、热带念珠菌和近平滑念珠菌的分离株中，观察到氟康唑药敏的变化很小。这些菌种占所有BSI的78%，并且在1992年至2001年期间，无论地理来源如何，对氟康唑仍高度敏感（91 - 100%敏感）。光滑念珠菌分离株中氟康唑耐药的发生率随时间以及在各个国家和地区有所不同。在美国，光滑念珠菌分离株对氟康唑的耐药性最高，并且因美国人口普查区域而异（范围为0 - 23%）。相对于氟康唑作为治疗念珠菌BSI的全身活性抗真菌药物的持续有效性而言，这些观察结果总体上令人鼓舞。
