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真菌血症的流行病学变化及其对抗真菌药物处方建议的潜在影响:一项全国性真菌血症监测计划的数据。

Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme.

机构信息

Unit of Mycology, Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark.

出版信息

Clin Microbiol Infect. 2013 Aug;19(8):E343-53. doi: 10.1111/1469-0691.12212. Epub 2013 Apr 22.

Abstract

Significant changes in the management of fungaemia have occurred over the last decade with increased use of fluconazole prophylaxis, of empirical treatment and of echinocandins as first-line agents for documented disease. These changes may impact the epidemiology of fungaemia. We present nationwide data for Denmark from 2010 to 2011. A total of 1081 isolates from 1047 episodes were recorded in 995 patients. The numbers of patients, episodes and recovered isolates increased by 13.1%, 14.5% and 14.1%, respectively, from 2010 to 2011. The incidence rate was significantly higher in 2011 (10.05/100 000) than in 2010 (8.82/100 000), but remained constant in the age groups 0-79 years. The incidence rate was highest at the extremes of age and in males. Candida albicans accounted for 52.1% but declined during 2004-11 (p 0.0155). Candida glabrata accounted for 28% and increased during 2004-2011 (p <0.0001). Candida krusei, Candida tropicalis and Candida parapsilosis remained rare (3.3-4.2%). The species distribution changed with increasing age (fewer C. parapsilosis and more C. glabrata) and by study centre. Overall, the susceptibility rates were: amphotericin B 97.3%, anidulafungin 93.8%, fluconazole 66.7%, itraconazole 69.6%, posaconazole 64.2% and voriconazole 85.0%. Acquired echinocandin resistance was molecularly confirmed in three isolates. The use of systemic antifungals doubled over the last decade (2002-2011) (from 717 000 to 1 450 000 defined daily doses/year) of which the vast majority (96.9%) were azoles. The incidence of fungaemia continues to increase in Denmark and is associated with a decreasing proportion being susceptible to fluconazole. Changes in demography, higher incidence in the elderly and higher antifungal consumption can at least in part explain the changes.

摘要

在过去十年中,真菌血症的治疗方法发生了重大变化,氟康唑预防用药、经验性治疗和棘白菌素类药物作为确诊疾病的一线药物的使用有所增加。这些变化可能会影响真菌血症的流行病学。我们呈现了来自丹麦 2010 年至 2011 年的全国数据。在 995 名患者的 1047 例中,共记录了 1081 株分离株。与 2010 年相比,2011 年患者、发作和恢复分离株的数量分别增加了 13.1%、14.5%和 14.1%。2011 年的发病率(10.05/100000)明显高于 2010 年(8.82/100000),但在 0-79 岁年龄组中保持不变。发病率在年龄较大和男性中最高。白念珠菌占 52.1%,但在 2004-2011 年期间下降(p<0.0155)。光滑念珠菌占 28%,在 2004-2011 年期间增加(p<0.0001)。近平滑念珠菌、热带念珠菌和克柔念珠菌仍然很少见(3.3-4.2%)。随着年龄的增长(假丝酵母菌属减少,光滑念珠菌增加)和研究中心的不同,物种分布发生了变化。总体而言,敏感性率为:两性霉素 B 97.3%、阿尼达卢芬净 93.8%、氟康唑 66.7%、伊曲康唑 69.6%、泊沙康唑 64.2%和伏立康唑 85.0%。在三个分离株中分子证实了获得性棘白菌素耐药性。过去十年中,系统抗真菌药物的使用增加了一倍(2002-2011 年)(从 717000 至 1450000 定义日剂量/年),其中绝大多数(96.9%)为唑类药物。丹麦的真菌血症发病率继续上升,并且对氟康唑的敏感性降低。人口统计学的变化、老年人发病率的增加和更高的抗真菌药物消耗至少可以部分解释这些变化。

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