Simões-Silva Liliana, Silva Sara, Santos-Araujo Carla, Sousa Joana, Pestana Manuel, Araujo Ricardo, Soares-Silva Isabel, Sampaio-Maia Benedita
i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen 208, 4200-180 Porto, Portugal.
Can J Infect Dis Med Microbiol. 2017;2017:4846363. doi: 10.1155/2017/4846363. Epub 2017 Dec 21.
Peritonitis and exit-site infections are important complications in peritoneal dialysis (PD) patients that are occasionally caused by opportunistic fungi inhabiting distant body sites. In this study, the oral yeast colonization of PD patients and the antifungal susceptibility profile of the isolated yeasts were accessed and correlated with fungal infection episodes in the following 4 years. Saliva yeast colonization was accessed in 21 PD patients and 27 healthy controls by growth in CHROMagar-Candida® and 18S rRNA/ITS sequencing. PD patients presented a lower oral yeast prevalence when compared to controls, namely, . Other species were also isolated, and . The antifungal susceptibility profiles of these isolates revealed resistance to itraconazole, variable susceptibility to caspofungin, and higher MIC values of posaconazole compared to previous reports. The 4-year longitudinal evaluation of these patients revealed and as PD-related exit-site infectious agents, but no correlation was found with oral yeast colonization. This pilot study suggests that oral yeast colonization may represent a limited risk for fungal infection development in PD patients. Oral yeast isolates presented a variable antifungal susceptibility profile, which may suggest resistance to some second-line drugs, highlighting the importance of antifungal susceptibility assessment in the clinical practice.
腹膜炎和出口处感染是腹膜透析（PD）患者的重要并发症，偶尔由寄居在身体其他部位的机会性真菌引起。在本研究中，对PD患者的口腔酵母菌定植情况以及分离出的酵母菌的抗真菌药敏谱进行了评估，并与随后4年的真菌感染发作情况进行了关联分析。通过在科玛嘉念珠菌显色培养基（CHROMagar-Candida®）上生长及18S rRNA/ITS测序，对21例PD患者和27名健康对照者的唾液酵母菌定植情况进行了评估。与对照组相比，PD患者的口腔酵母菌患病率较低，即 。还分离出了其他菌种， 以及 。这些分离株的抗真菌药敏谱显示对伊曲康唑耐药，对卡泊芬净敏感性不一，且泊沙康唑的最低抑菌浓度（MIC）值高于以往报道。对这些患者进行的4年纵向评估显示， 和 为与PD相关出口处感染的病原体，但未发现与口腔酵母菌定植存在相关性。这项初步研究表明，口腔酵母菌定植可能对PD患者发生真菌感染的风险有限。口腔酵母菌分离株呈现出不同的抗真菌药敏谱，这可能提示对某些二线药物耐药，凸显了在临床实践中进行抗真菌药敏评估的重要性。
