Chander Jagdish, Singla Nidhi, Sidhu Shailpreet Kaur, Gombar Satinder
Government Medical College Hospital, Chandigarh, India.
J Infect Dev Ctries. 2013 Sep 16;7(9):670-5. doi: 10.3855/jidc.2623.
Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has changed with the emergence of non-albicans Candida species, especially among critically ill patients.
In a retrospective study (July 2009 to December 2009) on candidemia, various Candida species isolated from blood cultures were characterized and studied along with the determination of their antifungal susceptibility to amphotericin B, itraconazole, and fluconazole by Etest. Probable risk factors for patients in the intensive care unit (ICU) presenting with candidemia were also analyzed.
During the study period, a total of 4651 samples were received, out of which 468 samples (10.06%) were positive for growth of organisms: 441 (94.20%) aerobic bacterial pathogens and 27 (5.79%) Candida species. The most common Candida spp. isolate was C. tropicalis (40.8%) followed by C. albicans (29.6%), C. glabrata (18.5%) and others (11.1%). Out of the 27 Candida strains, 24 (88.9%) were isolated from patients treated in the ICU. Among these, association of previous use of broad-spectrum antibiotics in 22 patients (91.6%) and central line catheter insertion in 20 patients (83.3%) were found to be statistically significant as compared to non-candidemia patients (p <0.05). Antifungal susceptibility testing of the isolates revealed a lower level of drug resistance to amphotericin B (18.5% of the isolates) versus 77.8% resistance to fluconazole.
Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious bloodstream fungal infection.
念珠菌属引起的血流感染正成为住院患者发病和死亡的主要原因。随着非白色念珠菌的出现，念珠菌血症的范围发生了变化，尤其是在重症患者中。
在一项关于念珠菌血症的回顾性研究（2009年7月至2009年12月）中，对从血培养中分离出的各种念珠菌进行了鉴定和研究，并通过Etest测定了它们对两性霉素B、伊曲康唑和氟康唑的抗真菌药敏性。还分析了重症监护病房（ICU）中念珠菌血症患者的可能危险因素。
在研究期间，共收到4651份样本，其中468份样本（10.06%）微生物生长呈阳性：441份（94.20%）为需氧细菌病原体，27份（5.79%）为念珠菌属。最常见的念珠菌分离株是热带念珠菌（40.8%），其次是白色念珠菌（29.6%）、光滑念珠菌（18.5%）和其他念珠菌（11.1%）。在27株念珠菌中，24株（88.9%）是从ICU接受治疗的患者中分离出来的。其中，与非念珠菌血症患者相比，22例患者（91.6%）既往使用广谱抗生素以及20例患者（83.3%）插入中心静脉导管的相关性具有统计学意义（p<0.05）。分离株的抗真菌药敏试验显示，对两性霉素B的耐药水平较低（18.5%的分离株），而对氟康唑的耐药率为77.8%。
感染率、潜在危险因素的快速变化以及非白色念珠菌的出现，需要对这种严重的血流真菌感染持续进行监测。
