在埃塞俄比亚西北部，晚期艾滋病患者中频繁检测到“唑类”耐药念珠菌属。
Frequent detection of 'azole' resistant Candida species among late presenting AIDS patients in northwest Ethiopia.
机构信息
Department of Microbiology, Parasitology and Immunology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
BMC Infect Dis. 2013 Feb 12;13:82. doi: 10.1186/1471-2334-13-82.
BACKGROUND
The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient's leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia.
METHODS
Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method.
RESULTS
The colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent.
CONCLUSION
HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.
背景
在治疗真菌感染（尤其是艾滋病患者的口腔念珠菌病）时，长期使用抗真菌药物会导致菌株对抗真菌药物产生耐药性，并改变念珠菌的种类。本研究旨在确定在埃塞俄比亚西北部晚期艾滋病患者中，念珠菌分离株的物种多样性和体外药敏情况。
方法
对 221 例 HIV/AIDS 患者进行了评估，采用标准化评估表进行评估。在 37°C 下将口腔冲洗液接种在 CHROMagar 平板上培养 48 小时，采用标准微生物学技术对念珠菌进行鉴定。采用肉汤微量稀释法进行体外药敏试验。
结果
发现念珠菌的定植率为 82.3%（177/215）。从 139 例（81%）患者中分离出的主要菌种为白色念珠菌，但也存在其他菌种的多样性。在 22.5%（40/177）的患者中最常分离出近平滑念珠菌，其次为热带念珠菌 14.1%（27/177）、克柔念珠菌 5.6%（10）和其他无法鉴定的念珠菌 4%（7/177）。复发性口腔念珠菌病和先前使用抗真菌药物被认为是导致非白色念珠菌定植的危险因素。无论鉴定出的念珠菌种类如何，有 12.2%（11/90）、7.7%（7/90）和 4.7%（4）的分离株对氟康唑、酮康唑和伊曲康唑分别具有耐药性。相比之下，对米卡芬净、两性霉素 B 和 5-氟胞嘧啶的耐药性则较为罕见。
结论
HIV/AIDS 患者口腔被单一或多种白色念珠菌和非白色念珠菌定植，这些念珠菌对唑类药物经常耐药，偶尔对两性霉素 B、5-氟胞嘧啶和米卡芬净耐药。这凸显了进行全国性监测以检查念珠菌流行病学和抗真菌药物耐药性的必要性。
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