Swedish Institute for Infectious Disease Control, Solna, Sweden.
J Clin Microbiol. 2011 Jul;49(7):2516-21. doi: 10.1128/JCM.00201-11. Epub 2011 May 4.
The susceptibilities of Candida isolates to the echinocandins anidulafungin, caspofungin, and micafungin were determined by using the recently revised CLSI breakpoints and Etest on 238 clinical bloodstream Candida isolates collected between September 2005 and August 2006. The isolates represent approximately 95% of all non-albicans Candida bloodstream infections and one-third of Candida albicans bloodstream infections during this 1-year period in Sweden. The collection included 81 C. albicans, 81 C. glabrata, 36 C. parapsilosis, 14 C. dubliniensis, 8 C. tropicalis, 8 C. lusitaniae, 5 C. krusei, 2 C. guilliermondii and 2 C. inconspicua isolates as well as 1 C. pelliculosa isolate. The MICs were largely consistent with the global epidemiology of bloodstream Candida isolates. All C. albicans and C. glabrata isolates were susceptible to all 3 echinocandins (MIC ≤ 0.016 μg/ml in all instances). Resistance (MIC ≥ 8 μg/ml) to anidulafungin alone was observed for 4 (11.1%) C. parapsilosis isolates and for 1/2 C. guilliermondii isolates. Intermediate susceptibility to caspofungin alone was observed for 2/5 C. krusei isolates. One of the eight C. tropicalis isolates was classified as being intermediately susceptible to micafungin (MIC, 0.5 μg/ml) and as being resistant to anidulafungin and caspofungin (MIC ≥ 1 μg/ml). This isolate harbored a heterozygous FKS1 hot spot mutation (S80P) known to confer echinocandin resistance. This first study to apply the revised CLSI breakpoints for Etest endpoints showed that the breakpoints worked successfully in detecting an isolate with a hot spot mutation. Acquired echinocandin resistance is rare in Sweden. Echinocandin MICs against C. parapsilosis and C. guilliermondii were lowest for micafungin.
采用最近修订的 CLSI 折点和 Etest 方法，对 2005 年 9 月至 2006 年 8 月间收集的 238 株临床血流感染念珠菌分离株进行了棘白菌素类药物（安尼卡宾、卡泊芬净和米卡芬净）药敏试验。这些分离株代表了瑞典该 1 年间 95%的非白念珠菌血流感染和三分之一的白念珠菌血流感染。该研究共收集了 81 株白念珠菌、81 株光滑念珠菌、36 株近平滑念珠菌、14 株都柏林念珠菌、8 株热带念珠菌、8 株卢比康唑、5 株克柔念珠菌、2 株季也蒙念珠菌和 2 株无名念珠菌分离株，以及 1 株pelliculosa 分离株。MIC 与血流感染念珠菌的全球流行病学基本一致。所有白念珠菌和光滑念珠菌分离株均对 3 种棘白菌素类药物敏感（所有菌株 MIC≤0.016μg/ml）。4 株（11.1%）近平滑念珠菌和 2 株（100%）季也蒙念珠菌对安尼卡宾单独耐药（MIC≥8μg/ml）。5 株克柔念珠菌中有 2 株对卡泊芬净单独中介（MIC 为 0.5μg/ml）。8 株热带念珠菌中有 1 株对米卡芬净中介（MIC 为 0.5μg/ml），对安尼卡宾和卡泊芬净耐药（MIC≥1μg/ml）。该株分离株携带一个已知与棘白菌素类药物耐药相关的 FKS1 热点突变（S80P）。该研究是首次应用修订后的 CLSI 折点进行 Etest 终点检测，结果表明该折点能成功检测到携带热点突变的分离株。瑞典棘白菌素类药物耐药的获得性非常罕见。米卡芬净对近平滑念珠菌和季也蒙念珠菌的 MIC 最低。
