Cleveland Angela Ahlquist, Harrison Lee H, Farley Monica M, Hollick Rosemary, Stein Betsy, Chiller Tom M, Lockhart Shawn R, Park Benjamin J
Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2015 Mar 30;10(3):e0120452. doi: 10.1371/journal.pone.0120452. eCollection 2015.
Recent reports have demonstrated a decline in bacterial bloodstream infections (BSIs) following adherence to central line insertion practices; however, declines have been less evident for BSIs due to Candida species.
We conducted active, population-based laboratory surveillance for candidemia in metropolitan Atlanta, GA and Baltimore, MD over a 5-year period. We calculated annual candidemia incidence and antifungal drug resistance rates.
We identified 3,848 candidemia cases from 2008-2013. Compared with 2008, candidemia incidence per 100,000 person-years decreased significantly by 2013 in both locations (GA: 14.1 to 9.5, p<0.001; MD: 30.9 to 14.4, p<0.001). A total of 3,255 cases (85%) had a central venous catheter (CVC) in place within 2 days before the BSI culture date. In both locations, the number of CVC-associated cases declined (GA: 473 to 294; MD: 384 to 151). Candida albicans (CA, 36%) and Candida glabrata (CG, 27%) were the most common species recovered. In both locations, the proportion of cases with fluconazole resistance decreased (GA: 8.0% to 7.1%, -10%; MD: 6.6% to 4.9%, -25%), while the proportion of cases with an isolate resistant to an echinocandin increased (GA: 1.2% to 2.9%, +147%; MD: 2.0% to 3.5%, +77%). Most (74%) echinocandin-resistant isolates were CG; 17 (<1%) isolates were resistant to both drug categories (multidrug resistant [MDR], 16/17 were CG). The proportion of CG cases with MDR Candida increased from 1.8% to 2.6%.
We observed a significant decline in the incidence of candidemia over a five-year period, and increases in echinocandin-resistant and MDR Candida. Efforts to strengthen infection control practices may be preventing candidemia among high-risk patients. Further surveillance for resistant Candida is warranted.
近期报告显示，遵循中心静脉导管插入操作规范后，细菌性血流感染（BSIs）有所下降；然而，念珠菌属导致的BSIs下降并不明显。
我们在佐治亚州亚特兰大市和马里兰州巴尔的摩市开展了为期5年的基于人群的念珠菌血症主动实验室监测。我们计算了念珠菌血症的年发病率和抗真菌药物耐药率。
我们在2008年至2013年期间共识别出3848例念珠菌血症病例。与2008年相比，到2013年这两个地区每10万人年的念珠菌血症发病率均显著下降（佐治亚州：从14.1降至9.5，p<0.001；马里兰州：从30.9降至14.4，p<0.001）。共有3255例（85%）病例在BSI培养日期前2天内留置了中心静脉导管（CVC）。在这两个地区，CVC相关病例数均有所下降（佐治亚州：从473例降至294例；马里兰州：从384例降至151例）。白色念珠菌（CA，36%）和光滑念珠菌（CG，27%）是最常见的分离菌种。在这两个地区，对氟康唑耐药的病例比例均有所下降（佐治亚州：从8.0%降至7.1%，下降10%；马里兰州：从6.6%降至4.9%，下降25%），而对棘白菌素耐药的病例比例有所增加（佐治亚州：从1.2%升至2.9%，增加147%；马里兰州：从2.0%升至3.5%，增加77%）。大多数（74%）对棘白菌素耐药的分离菌为CG；17株（<1%）分离菌对两类药物均耐药（多重耐药[MDR]，16/17为CG）。CG病例中MDR念珠菌的比例从1.8%升至2.6%。
我们观察到在五年期间念珠菌血症发病率显著下降，以及对棘白菌素耐药和MDR念珠菌的增加。加强感染控制措施的努力可能正在预防高危患者发生念珠菌血症。有必要进一步监测耐药念珠菌。
