Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Section of Infectious Diseases, Department of Internal Medicine, Taichung Hospital, Taichung, Taiwan.
Section of Infectious Diseases, Department of Internal Medicine, Taichung Hospital, Taichung, Taiwan.
J Microbiol Immunol Infect. 2018 Aug;51(4):552-558. doi: 10.1016/j.jmii.2016.08.015. Epub 2017 May 17.
Candida guilliermondii is rarely isolated from clinical specimen. C. guilliermondii fungemia is seldom reported in the literature. The aims of this study were to report the clinical features, antifungal susceptibility, and outcomes of patients with C. guilliermondii fungemia.
From 2003 to 2015, we retrospectively analyzed the clinical and laboratory data of patients with C. guilliermondii fungemia in a tertiary hospital in mid-Taiwan. We performed a multivariable logistic regression analysis to identify the risk factors of mortality. The Sensititre YeastOne microtiter panel assessed the susceptibility of antifungal agents.
In this study, we identified 36 patients with C. guilliermondii fungemia. The median age of patients was 50.5 years (range, 17 days to 96 year) and 20 cases (56%) were male. The incidence of C. guilliermondii fungemia was 0.05 per 1000 admissions. Malignancy was the most common co-morbidity, and 25 (69%) patients had central venous catheter in place. Thirty-day overall mortality was 16.7%. In multivariate logistical regression analysis, catheter retention was an independent risk factor of mortality. According to epidemiological cutoff values, most clinical isolates (21/22, 95.5%) belonged to the wild-type MIC distributions for amphotericin B and flucytosine; however, the isolates were less susceptible to fluconazole (68%) and echinocandins (77-91%).
Despite the lower mortality rate associated with C. guilliermondii fungemia, the removal of a central venous catheter remained an independent factor influencing the outcome of patients. The clinical significance of less susceptibility of C. guilliermondii to triazoles and echinocandins remains to be elucidated.
假丝酵母菌属中，格特隐球菌很少从临床标本中分离出来。文献中很少报道假丝酵母菌属格特隐球菌血症。本研究旨在报告假丝酵母菌属格特隐球菌血症患者的临床特征、抗真菌药敏性和转归。
2003 年至 2015 年，我们回顾性分析了台湾中部一家三级医院假丝酵母菌属格特隐球菌血症患者的临床和实验室数据。我们进行了多变量逻辑回归分析，以确定死亡率的危险因素。Sensititre YeastOne 微量板法评估了抗真菌药物的敏感性。
本研究共确定了 36 例假丝酵母菌属格特隐球菌血症患者。患者的中位年龄为 50.5 岁（范围为 17 天至 96 岁），20 例（56%）为男性。假丝酵母菌属格特隐球菌血症的发病率为 0.05/1000 例。恶性肿瘤是最常见的合并症，25 例（69%）患者有中心静脉导管。30 天总死亡率为 16.7%。在多变量逻辑回归分析中，导管留置是死亡的独立危险因素。根据流行病学临界值，大多数临床分离株（22 株中的 21 株，95.5%）对两性霉素 B 和氟胞嘧啶的野生型 MIC 分布属于敏感；然而，这些分离株对氟康唑（68%）和棘白菌素类（77-91%）的敏感性较低。
尽管假丝酵母菌属格特隐球菌血症的死亡率较低，但中心静脉导管的去除仍然是影响患者预后的独立因素。假丝酵母菌属对三唑类和棘白菌素类药物敏感性降低的临床意义仍有待阐明。
