挪威光滑念珠菌临床分离株的多样性及抗真菌药敏性
Diversity and antifungal susceptibility of Norwegian Candida glabrata clinical isolates.
作者信息
Andersen Kari-Mette, Kristoffersen Anne Karin, Ingebretsen André, Vikholt Katharina Johnsen, Örtengren Ulf Thore, Olsen Ingar, Enersen Morten, Gaustad Peter
机构信息
Institute of Clinical Odontology, University of Tromsø, Tromsø, Norway.
Department of Oral Biology (DOB), Faculty of Dentistry, University of Oslo, Oslo, Norway;
出版信息
J Oral Microbiol. 2016 Feb 8;8:29849. doi: 10.3402/jom.v8.29849. eCollection 2016.
BACKGROUND
Increasing numbers of immunocompromised patients have resulted in greater incidence of invasive fungal infections with high mortality. Candida albicans infections dominate, but during the last decade, Candida glabrata has become the second highest cause of candidemia in the United States and Northern Europe. Reliable and early diagnosis, together with appropriate choice of antifungal treatment, is needed to combat these challenging infections.
OBJECTIVES
To confirm the identity of 183 Candida glabrata isolates from different human body sites using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) and VITEK(®)2, and to analyze isolate protein profiles and antifungal susceptibility. The minimum inhibitory concentration (MIC) of seven antifungal drugs was determined for the isolates to elucidate susceptibility.
DESIGN
A total of 183 C. glabrata isolates obtained between 2002 and 2012 from Norwegian health-care units were analyzed. For species verification and differentiation, biochemical characterization (VITEK(®)2) and mass spectrometry (MALDI-TOF) were used. MIC determination for seven antifungal drugs was undertaken using E-tests(®).
RESULTS
Using VITEK(®)2, 92.9% of isolates were identified as C. glabrata, while all isolates (100%) were identified as C. glabrata using MALDI-TOF. Variation in protein spectra occurred for all identified C. glabrata isolates. The majority of isolates had low MICs to amphotericin B (≤1 mg/L for 99.5%) and anidulafungin (≤0.06 mg/L for 98.9%). For fluconazole, 18% of isolates had MICs >32 mg/L and 82% had MICs in the range ≥0.016 mg/L to ≤32 mg/L.
CONCLUSIONS
Protein profiles and antifungal susceptibility characteristics of the C. glabrata isolates were diverse. Clustering of protein profiles indicated that many azole resistant isolates were closely related. In most cases, isolates had highest susceptibility to amphotericin B and anidulafungin. The results confirmed previous observations of high MICs to fluconazole and flucytosine. MALDI-TOF was more definitive than VITEK(®)2 for C. glabrata identification.
背景
免疫功能低下患者数量不断增加，导致侵袭性真菌感染的发病率更高，死亡率也很高。白色念珠菌感染占主导地位，但在过去十年中，光滑念珠菌已成为美国和北欧念珠菌血症的第二大病因。需要可靠的早期诊断以及合适的抗真菌治疗选择来对抗这些具有挑战性的感染。
目的
使用基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF）和VITEK(®)2确认来自不同人体部位的183株光滑念珠菌分离株的身份，并分析分离株的蛋白质谱和抗真菌药敏性。测定了分离株对七种抗真菌药物的最低抑菌浓度（MIC）以阐明药敏性。
设计
分析了2002年至2012年间从挪威医疗机构获得的总共183株光滑念珠菌分离株。使用生化鉴定（VITEK(®)2）和质谱分析（MALDI-TOF）进行菌种鉴定和区分。使用E-test(®)对七种抗真菌药物进行MIC测定。
结果
使用VITEK(®)2，92.9%的分离株被鉴定为光滑念珠菌，而使用MALDI-TOF时所有分离株（100%）均被鉴定为光滑念珠菌。所有鉴定为光滑念珠菌的分离株均出现蛋白质谱变异。大多数分离株对两性霉素B的MIC较低（99.5%≤1mg/L）和对阿尼芬净的MIC较低（98.9%≤0.06mg/L）。对于氟康唑，18%的分离株MIC>32mg/L，82%的分离株MIC在≥0.016mg/L至≤32mg/L范围内。
结论
光滑念珠菌分离株的蛋白质谱和抗真菌药敏性特征各不相同。蛋白质谱聚类表明许多唑类耐药分离株密切相关。在大多数情况下，分离株对两性霉素B和阿尼芬净的药敏性最高。结果证实了先前关于对氟康唑和氟胞嘧啶高MIC的观察结果。对于光滑念珠菌鉴定，MALDI-TOF比VITEK(®)2更具确定性。
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