JMI Laboratories, North Liberty, Iowa, USA.
J Clin Microbiol. 2013 Aug;51(8):2571-81. doi: 10.1128/JCM.00308-13. Epub 2013 May 29.
The SENTRY Antimicrobial Surveillance Program monitors global susceptibility and resistance rates of newer and established antifungal agents. We report the echinocandin and triazole antifungal susceptibility patterns for 3,418 contemporary clinical isolates of yeasts and molds. The isolates were obtained from 98 laboratories in 34 countries during 2010 and 2011. Yeasts not presumptively identified by CHROMagar, the trehalose test, or growth at 42°C and all molds were sequence identified using internal transcribed spacer (ITS) and 28S (yeasts) or ITS, translation elongation factor (TEF), and 28S (molds) genes. Susceptibility testing was performed against 7 antifungals (anidulafungin, caspofungin, micafungin, fluconazole, itraconazole, posaconazole, and voriconazole) using CLSI methods. Rates of resistance to all agents were determined using the new CLSI clinical breakpoints and epidemiological cutoff value criteria, as appropriate. Sequencing of fks hot spots was performed for echinocandin non-wild-type (WT) strains. Isolates included 3,107 from 21 Candida spp., 146 from 9 Aspergillus spp., 84 from Cryptococcus neoformans, 40 from 23 other mold species, and 41 from 9 other yeast species. Among Candida spp., resistance to the echinocandins was low (0.0 to 1.7%). Candida albicans and Candida glabrata that were resistant to anidulafungin, caspofungin, or micafungin were shown to have fks mutations. Resistance to fluconazole was low among the isolates of C. albicans (0.4%), Candida tropicalis (1.3%), and Candida parapsilosis (2.1%); however, 8.8% of C. glabrata isolates were resistant to fluconazole. Among echinocandin-resistant C. glabrata isolates from 2011, 38% were fluconazole resistant. Voriconazole was active against all Candida spp. except C. glabrata (10.5% non-WT), whereas posaconazole showed decreased activity against C. albicans (4.4%) and Candida krusei (15.2% non-WT). All agents except for the echinocandins were active against C. neoformans, and the triazoles were active against other yeasts (MIC90, 2 μg/ml). The echinocandins and triazoles were active against Aspergillus spp. (MIC90/minimum effective concentration [MEC90] range, 0.015 to 2 μg/ml), but the echinocandins were not active against other molds (MEC90 range, 4 to >16 μg/ml). Overall, echinocandin and triazole resistance rates were low; however, the fluconazole and echinocandin coresistance among C. glabrata strains warrants continued close surveillance.
SENTRY 抗菌监测计划监测全球新型和已上市抗真菌药物的敏感性和耐药率。我们报告了 3418 株当代临床酵母和霉菌的棘白菌素和三唑类抗真菌药物敏感性模式。这些分离株是在 2010 年至 2011 年期间从 98 个实验室的 34 个国家获得的。未通过 CHROMagar、海藻糖试验、42°C 生长或形态学鉴定的酵母和所有霉菌均使用内部转录间隔区 (ITS) 和 28S（酵母）或 ITS、翻译延伸因子 (TEF) 和 28S（霉菌）基因进行序列鉴定。使用 CLSI 方法对 7 种抗真菌药物（安尼卡汀、卡泊芬净、米卡芬净、氟康唑、伊曲康唑、泊沙康唑和伏立康唑）进行了药敏试验。使用新的 CLSI 临床折点和流行病学临界点标准确定了所有药物的耐药率，视情况而定。对棘白菌素非野生型 (WT) 菌株进行了 fks 热点测序。分离株包括 21 种念珠菌属中的 3107 株、9 种曲霉属中的 146 株、新生隐球菌中的 84 株、23 种其他霉菌种中的 40 株和 9 种其他酵母种中的 41 株。在念珠菌属中，对棘白菌素的耐药率较低（0.0 至 1.7%）。对安尼卡汀、卡泊芬净或米卡芬净耐药的白色念珠菌和光滑念珠菌显示出 fks 突变。分离株中白色念珠菌（0.4%）、热带念珠菌（1.3%）和近平滑念珠菌（2.1%）对氟康唑的耐药率较低；然而，8.8%的光滑念珠菌分离株对氟康唑耐药。2011 年，棘白菌素耐药的光滑念珠菌分离株中，38%对氟康唑耐药。伏立康唑对所有念珠菌属均有效（除了光滑念珠菌，10.5%为非 WT），而泊沙康唑对白色念珠菌（4.4%）和克柔念珠菌（15.2%非 WT）的活性降低。除棘白菌素外，所有药物对新生隐球菌均有效，三唑类药物对其他酵母有效（MIC90，2μg/ml）。棘白菌素和三唑类药物对曲霉属有效（MIC90/最小有效浓度 [MEC90] 范围，0.015 至 2μg/ml），但棘白菌素对其他霉菌无效（MEC90 范围，4 至>16μg/ml）。总的来说，棘白菌素和三唑类药物的耐药率较低；然而，光滑念珠菌中氟康唑和棘白菌素的核心耐药性值得持续密切监测。
