[西班牙过去10年真菌血症的流行病学变化及血液分离株对氟康唑的敏感性：FUNGEMYCA研究结果]
[Changes in the epidemiology of fungaemia and fluconazole susceptibility of blood isolates during the last 10 years in Spain: results from the FUNGEMYCA study].
作者信息
Pemán Javier, Cantón Emilia, Miñana Juan José Camarena, Florez Julia Alcoba, Echeverria Julia, Ortega David Navarro, Alarcón José Martínez, Fontanals Dionisia, Sard Bárbara Gomila, Moreno Buenaventura Buendía, Torroba Luis, Ayats Josefina, Pérez Miguel Ángel Bratos, Fernández María Alvarez, Reus Ferrán Sánchez, Natal Isabel Fernández, García Gloria Royo, Ezpeleta Guillermo, Martín-Mazuelos Estrella, Iglesias Isabel, Rezusta Antonio, de Ocariz Inmaculada Ramírez, Nieto Amelia Gómez
机构信息
Servicio de Microbiología, Hospital Universitario La Fe, Valencia, España.
出版信息
Rev Iberoam Micol. 2011 Apr-Jun;28(2):91-9. doi: 10.1016/j.riam.2011.02.005. Epub 2011 Mar 3.
BACKGROUND
Recent epidemiological surveillance studies have reported an increase in fungaemia caused by non-Candida albicans species, as well as a decrease in fluconazole susceptibility.
OBJECTIVES
To evaluate changes in the epidemiology of fungaemia in Spain comparing data from a new surveillance epidemiological study conducted in 2009 with a previous study carried out from 1997 to 1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005).
METHODS
From January 2009 to February 2010, 44 Spanish hospitals participated in a prospective multicentre fungaemia surveillance study to ascertain whether there have been changes in the epidemiology and fluconazole susceptibility. Susceptibility was determined by the colorimetric method Sensititre Yeast One. Demographic and clinical data and the first isolate of each episode were gathered.
RESULTS
A total of 1,377 isolates from 1,357 fungaemia episodes were collected, 46.7% from patients older than 64years and 8.6% from children less than 1 year old. C. albicans (44.7%), Candida parapsilosis (29.1%), Candida glabrata (11.5%), Candida tropicalis (8.2%), and Candida krusei (1.9%) were the most frequent species isolated. Distribution varied with the geographical area. C. albicans incidence has increased significantly in the last 10years in Cataluña (39.1 vs. 54.7%, P=0.03) and decreased in the Valencian Community (49.1 vs. 34.6%, P=0.002) and Extremadura (58.3 vs. 20%, P=0.01). Susceptibility to fluconazole was similar for all geographical areas, although resistance in C. albicans was ten times greater for patients aged more than 64years. The overall rate of fluconazole resistance (MIC > 32 mg/L) has decreased with respect to that obtained 10years ago (3.7 vs. 2.5%) mainly in C. albicans (3 vs. 1.6%).
CONCLUSIONS
In the last ten years, species distribution and fluconazole susceptibility have not significantly changed, although a lower rate of fluconazole resistance has been observed. Species distribution varies with hospital, hospitalization Unit and geographical area.
背景
近期的流行病学监测研究报告称，由非白色念珠菌引起的真菌血症有所增加，同时氟康唑敏感性有所下降。
目的
通过比较2009年开展的一项新的监测流行病学研究与1997年至1999年进行的一项先前研究（佩曼J等人，《欧洲临床微生物学与传染病杂志》，2005年）的数据，评估西班牙真菌血症流行病学的变化。
方法
2009年1月至2010年2月，44家西班牙医院参与了一项前瞻性多中心真菌血症监测研究，以确定流行病学和氟康唑敏感性是否发生了变化。敏感性通过比色法Sensititre Yeast One测定。收集了人口统计学和临床数据以及每例感染的首个分离株。
结果
共收集了1357例真菌血症发作的1377株分离株，46.7%来自64岁以上患者，8.6%来自1岁以下儿童。白色念珠菌（44.7%）、近平滑念珠菌（29.1%）、光滑念珠菌（11.5%）、热带念珠菌（8.2%）和克柔念珠菌（1.9%）是最常分离出的菌种。分布因地理区域而异。在过去10年中，加泰罗尼亚的白色念珠菌发病率显著增加（39.1%对54.7%，P = 0.03），而巴伦西亚自治区（49.1%对34.6%，P = 0.002）和埃斯特雷马杜拉（58.3%对20%，P = 0.01）则有所下降。所有地理区域对氟康唑的敏感性相似，尽管64岁以上患者中白色念珠菌的耐药性高出10倍。与10年前相比，氟康唑耐药总体率（MIC>32 mg/L）有所下降（3.7%对2.5%），主要是白色念珠菌（3%对1.6%）。
结论
在过去十年中，菌种分布和氟康唑敏感性虽未发生显著变化，但氟康唑耐药率有所降低。菌种分布因医院、住院科室和地理区域而异。
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