Department of Applied Genetics and Cell Biology (DAGZ), University of Natural Resources and Life Sciences, Vienna (BOKU), Austria.
Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
Mycoses. 2019 Apr;62(4):357-367. doi: 10.1111/myc.12892. Epub 2019 Feb 20.
Candida-associated infections put a significant burden on western healthcare systems. Development of (multi-)resistant fungi can become untreatable and threaten especially vulnerable target groups, such as the immunocompromised.
We assessed antifungal susceptibility and explored possible influence factors of clinical Candida isolates collected from Austrian hospitals between 2007 and 2016.
Thousand three hundred and sixty clinical Candida spp. isolated from blood cultures were subjected to antifungal susceptibility testing (AFST) in a liquid-handling aided continuous microdilution assay. We tested against fluconazole, voriconazole, posaconazole, itraconazole, isavuconazole, anidulafungin, caspofungin and micafungin according to EUCAST with additional recording of growth curves. We performed rigid quality control on each assay via growth curve assessment and included two standard reference strains. Minimal inhibitory concentrations (MIC) were quantified according to EUCAST guideline E.DEF 7.3.1, and susceptibility was evaluated using EUCAST clinical breakpoints.
The isolate collection consisted of Candida albicans (59%), C. glabrata (19%), C. parapsilosis (9%), C. tropicalis (5%) and C. krusei (3%) and few other Candida species and fungi (5%). During the observed time period, species abundance and antifungal resistance rates remained constant. Multi-resistance was rare and we found no single isolate which was resistant to both azoles and echinocandins. Within the antifungal resistance profile of our strain collection, we observed clusters along species boundaries.
Over the last decade, the distribution of Candida species and its level of antifungal resistance remained constant in Austria. Our data compare well with other European countries. Principal component analysis of the susceptibility profile of this collection revealed species-specific clusters and substantial intra-species variation, especially for C. glabrata.
念珠菌相关性感染给西方医疗体系带来了巨大负担。（多）耐药真菌的发展可能变得无法治疗，并特别威胁到免疫功能低下等脆弱目标群体。
我们评估了抗真菌药物敏感性，并探讨了 2007 年至 2016 年期间从奥地利医院采集的临床念珠菌分离株的可能影响因素。
对 1360 株来自血液培养的临床念珠菌进行了液体处理辅助连续微量稀释法抗真菌药敏试验（AFST）。我们根据 EUCAST 标准，用氟康唑、伏立康唑、泊沙康唑、伊曲康唑、艾沙康唑、阿尼芬净、卡泊芬净和米卡芬净进行了测试，并额外记录了生长曲线。我们通过生长曲线评估对每个检测进行了严格的质量控制，并包括两个标准参考菌株。最小抑菌浓度（MIC）根据 EUCAST 指南 E.DEF 7.3.1 进行定量，并使用 EUCAST 临床折点评估敏感性。
分离株采集物包括白色念珠菌（59%）、近平滑念珠菌（19%）、近平滑念珠菌（9%）、热带念珠菌（5%）和光滑念珠菌（3%）以及其他少数几种念珠菌和真菌（5%）。在观察期间，物种丰度和抗真菌药物耐药率保持不变。多耐药性很少见，我们没有发现同时对唑类和棘白菌素类药物都耐药的单个分离株。在我们的分离株抗药性特征中，我们观察到沿着种界的集群。
在过去的十年中，奥地利的念珠菌种分布及其抗真菌药物耐药水平保持不变。我们的数据与其他欧洲国家的数据相比非常吻合。对该分离株集的敏感性特征进行主成分分析，揭示了种特异性集群和种内变异，特别是对光滑念珠菌。
