Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi 110029, India.
Infection. 2010 Oct;38(5):387-93. doi: 10.1007/s15010-010-0044-x. Epub 2010 Jul 24.
Candida rugosa appears to be emerging as a distinctive cause of candidaemia in recent years. Candidaemia due to this species is important to recognise because of its decreased susceptibility to azoles.
We retrospectively evaluated a cluster of C. rugosa candidaemia occurring in critically ill trauma patients from a level I trauma centre of India. During the period from July 2008 to September 2009, a total of 28 blood samples from 19 patients were found to be positive for C. rugosa. Genetic relatedness among 17 C. rugosa isolates were characterised by the random amplified polymorphic DNA (RAPD) assay using M13 primers. These isolates were also characterised for their susceptibility to four antifungal agents, amphotericin B, fluconazole, flucytosine and voriconazole.
In our study, 21% of C. rugosa isolates were resistant to fluconazole, whereas 100% susceptibility to amphotericin B, flucytosine and voriconazole was noted. Thirteen out of the 19 patients (68.4%) with C. rugosa candidaemia died. Of these, six had received antifungal therapy after confirmation of fungaemia.
Prior to this cluster, C. rugosa had never been identified as a cause of infection at our centre. Due to the retrospective nature of the evaluation of these cases, the source of this possible outbreak could not be traced. Nevertheless, to the best of our knowledge, this is the largest cluster of cases of C. rugosa candidaemia reported from a single institution in the English literature.
近年来，皱褶假丝酵母似乎成为一种独特的念珠菌血症病原体。由于该物种对唑类药物的敏感性降低，因此识别由其引起的念珠菌血症很重要。
我们回顾性评估了来自印度一级创伤中心的重症创伤患者中发生的皱褶假丝酵母念珠菌血症的聚集。在 2008 年 7 月至 2009 年 9 月期间，从 19 名患者中总共发现了 28 份血样为皱褶假丝酵母阳性。使用 M13 引物的随机扩增多态性 DNA（RAPD）试验对 17 株皱褶假丝酵母分离株的遗传相关性进行了特征分析。还对这些分离株对四种抗真菌药物（两性霉素 B、氟康唑、氟胞嘧啶和伏立康唑）的敏感性进行了特征分析。
在我们的研究中，21%的皱褶假丝酵母分离株对氟康唑耐药，而对两性霉素 B、氟胞嘧啶和伏立康唑的敏感性为 100%。19 名患有皱褶假丝酵母念珠菌血症的患者中（68.4%）有 13 人死亡。其中，6 人在确认真菌血症后接受了抗真菌治疗。
在这一组病例之前，皱褶假丝酵母从未在我们中心被确定为感染的原因。由于对这些病例进行评估的回顾性性质，无法追踪此次可能暴发的来源。尽管如此，但据我们所知，这是迄今为止在英文文献中从单一机构报告的最大一组皱褶假丝酵母念珠菌血症病例。
