Farmakiotis Dimitrios, Tarrand Jeffrey J, Kontoyiannis Dimitrios P
Emerg Infect Dis. 2014 Nov;20(11):1833-40. doi: 10.3201/eid2011.140685.
Cancer patients are at risk for candidemia, and increasing Candida spp. resistance poses an emerging threat. We determined rates of antifungal drug resistance, identified factors associated with resistance, and investigated the correlation between resistance and all-cause mortality rates among cancer patients with ≥1 C. glabrata-positive blood culture at MD Anderson Cancer Center, Houston, Texas, USA, during March 2005-September 2013. Of 146 isolates, 30 (20.5%) were resistant to fluconazole, 15 (10.3%) to caspofungin, and 10 (6.8%) to multiple drugs (9 caspofungin-resistant isolates were also resistant to fluconazole, 1 to amphotericin B). Independently associated with fluconazole resistance were azole preexposure, hematologic malignancy, and mechanical ventilation. Independently associated with caspofungin resistance were echinocandin preexposure, monocytopenia, and total parenteral nutrition. Fluconazole resistance was highly associated with caspofungin resistance, independent of prior azole or echinocandin use. Caspofungin resistance was associated with increased 28-day all-cause mortality rates. These findings highlight the need for good stewardship of antifungal drugs.
癌症患者有发生念珠菌血症的风险，念珠菌属耐药性不断增加构成了新的威胁。我们在美国得克萨斯州休斯敦市MD安德森癌症中心，对2005年3月至2013年9月期间血培养光滑念珠菌阳性≥1次的癌症患者，测定了抗真菌药物耐药率，确定了与耐药相关的因素，并研究了耐药与全因死亡率之间的相关性。在146株分离株中，30株（20.5%）对氟康唑耐药，15株（10.3%）对卡泊芬净耐药，10株（6.8%）对多种药物耐药（9株对卡泊芬净耐药的分离株也对氟康唑耐药，1株对两性霉素B耐药）。与氟康唑耐药独立相关的因素有唑类药物预先暴露、血液系统恶性肿瘤和机械通气。与卡泊芬净耐药独立相关的因素有棘白菌素预先暴露、单核细胞减少和全胃肠外营养。氟康唑耐药与卡泊芬净耐药高度相关，与先前使用唑类或棘白菌素无关。卡泊芬净耐药与28天全因死亡率增加相关。这些发现凸显了对抗真菌药物进行良好管理的必要性。
