在 9 年期间（2009-2017 年），希腊一所大学医院的念珠菌血症发病率不断上升，且念珠菌属非白念珠菌的流行趋势有所转变。
Increasing incidence of candidaemia and shifting epidemiology in favor of Candida non-albicans in a 9-year period (2009-2017) in a university Greek hospital.
机构信息
Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Patras, Patras, Greece.
Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland.
出版信息
Infection. 2019 Apr;47(2):209-216. doi: 10.1007/s15010-018-1217-2. Epub 2018 Sep 8.
PURPOSE
The aim of the present study was to analyze candidaemia's epidemiology (incidence, species distribution, and susceptibility rates) and antifungal consumption during a 9-year period.
METHODS
All candidaemias recorded at The University General Hospital of Patras, Greece, between 2009 and 2017 were included. Candida isolates were identified using the germ tube test, API 20C AUX System, and/or Vitek-2 YST card. Antifungal susceptibility was determined by the gradient method according to CLSI.
RESULTS
During the study period, 505 episodes of candidaemia were observed with an overall incidence of 1.5 episodes per 1000 hospital admissions (1.1 episodes in 2009 to 1.9 in 2017: P 0.038, r 0.694). C. albicans was the leading cause (200 cases; 39.6%), followed by C. parapsilosis (185; 36.6%), C. glabrata (56; 11.1%), C. tropicalis (50; 9.9%), C. krusei (8; 0.2%), C. lusitaniae (5; < 0.1%), and C. guilliermondii (1; < 0.1%). Overall resistance to fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin (according to CLSI) were 11.6%, 4.1%, 2.0%, 6.0%, and 0.8%, respectively. The overall consumption of antifungal drugs was stable, with a significant reduction of fluconazole's use in favor of echinocandins.
CONCLUSIONS
An increase in the incidence of candidaemia and a predominance of Candida non-albicans due to decreasing use of fluconazole in favor of more potent antifungals, such as echinocandins, are reported in this study.
目的
本研究旨在分析 9 年间念珠菌血症的流行病学（发病率、菌种分布和药敏率）和抗真菌药物的使用情况。
方法
纳入 2009 年至 2017 年期间在希腊帕特雷大学综合医院记录的所有念珠菌血症病例。使用芽管试验、API 20C AUX 系统和/或 Vitek-2 YST 卡鉴定念珠菌分离株。根据 CLSI 采用梯度法测定抗真菌药敏率。
结果
研究期间共观察到 505 例念珠菌血症，总发病率为每 1000 例住院患者中有 1.5 例（2009 年为 1.1 例，2017 年为 1.9 例：P=0.038，r=0.694）。白念珠菌是主要病原体（200 例；39.6%），其次是近平滑念珠菌（185 例；36.6%）、光滑念珠菌（56 例；11.1%）、热带念珠菌（50 例；9.9%）、克柔念珠菌（8 例；0.2%）、葡萄牙念珠菌（5 例；<0.1%）和季也蒙念珠菌（1 例；<0.1%）。氟康唑、伏立康唑、阿尼芬净、卡泊芬净和米卡芬净（根据 CLSI）的总耐药率分别为 11.6%、4.1%、2.0%、6.0%和 0.8%。抗真菌药物的总使用量保持稳定，氟康唑的使用量减少，而棘白菌素类药物的使用量增加。
结论
本研究报告了念珠菌血症的发病率增加，以及由于氟康唑的使用减少，而非白念珠菌的优势增加，这是由于更有效的抗真菌药物（如棘白菌素类）的使用增加所致。
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