Mycology Unit, Adolfo Lutz Institute Adolfo Lutz, Av Dr Arnaldo 355, São Paulo 01246-902, Brazil.
Mycopathologia. 2012 Dec;174(5-6):389-96. doi: 10.1007/s11046-012-9566-3. Epub 2012 Jul 21.
To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.
为了描述三级保健医院血流感染念珠菌的发生率和易感性特征，我们进行了一项回顾性观察研究，时间范围为 1998 年至 2007 年。所有病例均从合并症和危险因素方面进行了编译。对 100 株分离株进行了氟康唑、伊曲康唑、伏立康唑和两性霉素 B 的体外药敏试验，对近平滑念珠菌复合体进行了卡泊芬净药敏试验。在十年的念珠菌血症评估中，44%由白色念珠菌引起，近平滑念珠菌复合体是第二常见的病原体（37%）。其他种属的发生率较低（热带念珠菌，13%；光滑念珠菌，5%；克柔念珠菌，1%）。本研究中未观察到都柏林念珠菌和中间型念珠菌。还发现了近平滑念珠菌（3%）和近平滑念珠菌严格意义上的同种（34%）。种属分布与置管、机械通气或先前使用抗真菌药物或皮质激素无关。肠外营养的给予与光滑念珠菌感染密切相关，该种属感染的死亡率最高（80%）。所有白色念珠菌分离株对所有测试药物均显示出高度敏感性。然而，有两个近平滑念珠菌严格意义上的同种分离株对氟康唑表现出高最小抑菌浓度（MIC）（各 4mg/L），一个表现出伏立康唑 MIC 为 0.25mg/L，突出了这些唑类药物的交叉耐药性。所有热带念珠菌和光滑念珠菌分离株对任何测试药物均无耐药性。无柄念珠菌和平滑念珠菌对卡泊芬净的敏感性无差异。我们的研究结果表明，巴西血流感染念珠菌分离株对两性霉素 B、氟康唑、伏立康唑、伊曲康唑和卡泊芬净的耐药性仍然罕见。
