单一中心十年念珠菌血流感染经验。
A single-centre 10-year experience with Candida bloodstream infections.
机构信息
Department of Microbiology-Infectious Diseases, Hôpital Maisonneuve-Rosemont;
出版信息
Can J Infect Dis Med Microbiol. 2009 Summer;20(2):45-50. doi: 10.1155/2009/731070.
OBJECTIVE
To describe the clinical and microbiological features associated with Candida bloodstream infections observed at Hôpital Maisonneuve-Rosemont (Montreal, Quebec) between August 1996 and July 2006.
METHODS
Episodes were retrieved from the microbiology laboratory. Different patient episodes and different isolate episodes in the same patient were selected. Antifungal susceptibility was determined by the Clinical and Laboratory Standards Institute's (USA) M27A2 method.
RESULTS
A total of 190 different episodes of candidemia in 185 patients were identified. Eleven (6%) episodes occurred in outpatients. Candida albicans was identified in the majority of episodes (57%). Its frequency remained stable over the years. The proportion of Candida krusei candidemia episodes increased between 2003 and 2006, but this was not statistically significant. A central venous indwelling catheter or a peripherally inserted central catheter line was present in the majority of patients (167 [88%]). Of the indwelling catheters removed at the time of diagnosis, 39% were positive for Candida species on culture. Overall, voriconazole was the most active agent (the minimum inhibitory concentration required to inhibit the growth of 90% of organisms was 0.5 mg/L). Resistance to fluconazole was observed in 26 (14%) isolates (C albicans, 4%; versus non-albicans Candida species, 27%; P<0.001). Being on the hematology-oncology unit at the time of diagnosis (adjusted OR 7.8; 95% CI 2.3 to 27.1; P=0.001) and having received fluconazole or itraconazole within the past three months (adjusted OR 8.3; 95% CI 2.8 to 24.4; P<0.001) were significantly associated with resistance to fluconazole in multivariate analysis.
CONCLUSIONS
At Hôpital Maisonneuve-Rosemont, the frequency and species distribution of blood isolates of Candida remained stable over the past decade. In vitro resistance of C albicans to fluconazole and itraconazole remained minimal; resistance of non-albicans Candida species to fluconazole did not increase significantly. The new antifungal agents all had high in vitro activity against the bloodstream Candida isolates.
目的
描述 1996 年 8 月至 2006 年 7 月期间在蒙特利尔 Maisonneuve-Rosemont 医院（魁北克）观察到的与念珠菌血流感染相关的临床和微生物学特征。
方法
从微生物学实验室中检索到病例。选择不同的患者病例和同一患者中的不同分离株病例。通过美国临床和实验室标准协会（CLSI）的 M27A2 方法确定抗真菌药物敏感性。
结果
共确定了 185 例患者中的 190 例不同的念珠菌血症病例。11 例（6%）发生在门诊患者中。大多数病例（57%）为白色念珠菌。其频率在过去几年中保持稳定。2003 年至 2006 年间，克柔念珠菌血症病例的比例有所增加，但无统计学意义。大多数患者（167 [88%]）存在中心静脉留置导管或外周插入的中心导管。在诊断时取出的留置导管中，39%的导管在培养物中呈念珠菌阳性。总的来说，伏立康唑是最有效的药物（抑制 90%的生物体生长所需的最低抑菌浓度为 0.5 毫克/升）。在 26 株（14%）分离株中观察到对氟康唑的耐药性（白色念珠菌，4%；而非白色念珠菌属念珠菌种，27%；P<0.001）。在诊断时处于血液肿瘤学病房（调整后的比值比 7.8；95%置信区间 2.3 至 27.1；P=0.001）和在过去三个月内接受过氟康唑或伊曲康唑治疗（调整后的比值比 8.3；95%置信区间 2.8 至 24.4；P<0.001）在多变量分析中与氟康唑耐药显著相关。
结论
在 Maisonneuve-Rosemont 医院，过去十年中血液分离株的念珠菌的频率和种属分布保持稳定。白色念珠菌对氟康唑和伊曲康唑的体外耐药性仍然很低；非白色念珠菌属念珠菌种对氟康唑的耐药性没有显著增加。新型抗真菌药物对血流念珠菌分离株均具有很高的体外活性。
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