Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, New Taipei, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
J Microbiol Immunol Infect. 2019 Aug;52(4):612-619. doi: 10.1016/j.jmii.2017.08.007. Epub 2017 Aug 26.
This retrospective study investigated clinical manifestations of candidemia caused by uncommon Candida species and antifungal susceptibility of the isolates in a regional hospital in Taiwan.
The uncommon Candida species was initially defined as Candida species other than C. albicans, C. tropicalis, C. glabrata complex, C. parapsilosis complex and C. krusei. All uncommon Candida isolates were identified and confirmed by molecular methods. In vitro susceptibility testing of the uncommon Candida species to nine antifungal agents was conducted using the broth microdilution method with the Sensititre YeastOne (SYO) system (Trek Diagnostic Systems, Ltd., East Grimstead, UK).
Twenty-one patients, comprising 11 males and 10 females with a median age of 69 years, were recruited. Cancer (n = 11) was the most common underlying disease, 19 (90.5%) cases had prior antibiotic exposure, and only two patients had prior antifungal use. The overall in-hospital mortality rate was 38.1% (n = 8). C. guilliermondii (n = 11) was the most common pathogen, followed by C. curvata (n = 3). C. guilliermondii isolates exhibited relatively high rates of azole minimum inhibitory concentrations (MICs) above epidemiological cut-off values (ECVs), whereas C. pelliculosa and C. lusitaniae isolates all remained susceptible to azoles. All three C. curvata isolates had high caspofungin (>8 mg/L) and fluconazole MICs (8 mg/L) and could be defined as multidrug-resistant.
Uncommon Candida species frequently exhibit high rates of non-susceptibility to antifungals. Identification of all Candida isolates at the species level from blood samples is of value for treatment.
本回顾性研究调查了在台湾一家地区医院引起罕见念珠菌血症的临床表现和分离株的抗真菌药敏性。
罕见念珠菌最初被定义为除白色念珠菌、热带念珠菌、光滑念珠菌复合体、近平滑念珠菌复合体和克柔念珠菌以外的念珠菌。所有罕见念珠菌分离株均通过分子方法进行鉴定和确认。采用 Sensititre YeastOne（SYO）系统（英国 Trek 诊断系统有限公司）肉汤微量稀释法对罕见念珠菌对 9 种抗真菌药物的体外药敏性进行检测。
共纳入 21 例患者，包括 11 例男性和 10 例女性，中位年龄 69 岁。癌症（n=11）是最常见的基础疾病，19 例（90.5%）患者有既往抗生素暴露史，仅有 2 例患者有既往抗真菌药物使用史。总的院内死亡率为 38.1%（n=8）。最常见的病原体是近平滑念珠菌（n=11），其次是假热带念珠菌（n=3）。近平滑念珠菌分离株的唑类最低抑菌浓度（MIC）高于流行病学折点（ECV）的比例较高，而pelliculosa 念珠菌和葡萄牙念珠菌分离株均对唑类药物敏感。3 株假热带念珠菌的卡泊芬净（>8mg/L）和氟康唑 MIC（8mg/L）均较高，可定义为多药耐药。
罕见念珠菌对抗真菌药物的耐药率较高。从血样中鉴定出所有念珠菌分离株的种水平对治疗有价值。
