Marcos-Zambrano Laura Judith, Escribano Pilar, Sánchez Carlos, Muñoz Patricia, Bouza Emilio, Guinea Jesús
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
Antimicrob Agents Chemother. 2014 Aug;58(8):4565-72. doi: 10.1128/AAC.02670-14. Epub 2014 May 27.
Accurate knowledge of fungemia epidemiology requires identification of strains to the molecular level. Various studies have shown that the rate of resistance to fluconazole ranges from 2.5% to 9% in Candida spp. isolated from blood samples. However, trends in antifungal resistance have received little attention and have been studied only using CLSI M27-A3 methodology. We assessed the fungemia epidemiology in a large tertiary care institution in Madrid, Spain, by identifying isolates to the molecular level and performing antifungal susceptibility testing according to the updated breakpoints of European Committee for Antimicrobial Susceptibility Testing (EUCAST) definitive document (EDef) 7.2. We studied 613 isolates causing 598 episodes of fungemia in 544 patients admitted to our hospital (January 2007 to December 2013). Strains were identified after amplification and sequencing of the ITS1-5.8S-ITS2 region and further tested for in vitro susceptibility to amphotericin B, fluconazole, posaconazole, voriconazole, micafungin, and anidulafungin. Resistance was defined using EUCAST species-specific breakpoints, and epidemiological cutoff values (ECOFFs) were applied as tentative breakpoints. Most episodes were caused by Candida albicans (46%), Candida parapsilosis (28.7%), Candida glabrata (9.8%), and Candida tropicalis (8%). Molecular identification enabled us to better detect cryptic species of Candida guilliermondii and C. parapsilosis complexes and episodes of polyfungal fungemia. The overall percentage of fluconazole-resistant isolates was 5%, although it was higher in C. glabrata (8.6%) and non-Candida yeast isolates (47.4%). The rate of resistance to echinocandins was 4.4% and was mainly due to the presence of intrinsically resistant non-Candida species. Resistance mainly affected non-Candida yeasts. The rate of resistance to fluconazole and echinocandins did not change considerably during the study period.
准确了解真菌血症的流行病学需要将菌株鉴定到分子水平。各种研究表明，从血液样本中分离出的念珠菌属对氟康唑的耐药率在2.5%至9%之间。然而，抗真菌药物耐药性的趋势很少受到关注，并且仅使用CLSI M27 - A3方法进行过研究。我们通过将分离株鉴定到分子水平，并根据欧洲抗菌药物敏感性试验委员会（EUCAST）确定性文件（EDef）7.2的更新断点进行抗真菌药敏试验，评估了西班牙马德里一家大型三级医疗机构的真菌血症流行病学情况。我们研究了我院（2007年1月至2013年12月）收治的544例患者中导致598次真菌血症发作的613株分离株。通过对ITS1 - 5.8S - ITS2区域进行扩增和测序来鉴定菌株，并进一步检测其对两性霉素B、氟康唑、泊沙康唑、伏立康唑、米卡芬净和阿尼芬净的体外敏感性。使用EUCAST物种特异性断点定义耐药性，并将流行病学临界值（ECOFFs）用作暂定断点。大多数发作由白色念珠菌（46%）、近平滑念珠菌（28.7%）、光滑念珠菌（9.8%）和热带念珠菌（8%）引起。分子鉴定使我们能够更好地检测季也蒙念珠菌和近平滑念珠菌复合体的隐性菌种以及多真菌性真菌血症发作。氟康唑耐药分离株的总体百分比为5%，尽管在光滑念珠菌（8.6%）和非念珠菌酵母分离株（47.4%）中更高。对棘白菌素的耐药率为4.4%，主要是由于存在固有耐药的非念珠菌属菌种。耐药性主要影响非念珠菌酵母。在研究期间，对氟康唑和棘白菌素的耐药率没有显著变化。
