Department of Biomedical Science for Health, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy.
Microbiology and Virology Unit IRCCS Policlinico San Matteo, Pavia, Italy.
J Mycol Med. 2020 Apr;30(1):100906. doi: 10.1016/j.mycmed.2019.100906. Epub 2019 Oct 15.
Fungemia represents a public health concern. Knowing aetiology and activity of the antifungals is critical for the management of bloodstream infections. Therefore, surveillance on local/international levels is desirable for a prompt administration of appropriate therapy.
Data on fungi responsible for fungemia and antifungal susceptibility profiles were collected from a laboratory-based surveillance over 2016-2017 in 12 hospitals located in Lombardia, Italy. The trend of this infection in twenty years was analysed.
A total of 1024 episodes were evaluated. Rate of candiaemia progressively increased up to 1.46/1000 admissions. C.albicans was the most common species (52%), followed by C. parapsilosis (15%) and C glabrata (13%). As in the previous surveys the antifungal resistance is rare (echinocandins<2%, fluconazole 6%, amphotericin B 0.6%). Fungi other than Candida were responsible for 18 episodes: Cryptococcus neoformans (5 cases), Fusarium spp. (4), Magnusiomyces clavatus (3), Saccharomyces cerevisiae (3), Rhodotorula spp. (2), Exophiala dermatitidis (1). All fungi, except S.cerevisiae, were intrinsically resistant to echinocandins. Some isolates showed also elevated azole MIC.
No particular changes in terms of species distribution and antifungal susceptibility patterns was noted. However, surveillance programs are needed to monitor trends in antifungal resistance, steer stewardship activities, orient empirical treatment.
菌血症是一个公共卫生问题。了解真菌的病因和抗真菌药物的活性对于血流感染的治疗至关重要。因此，在当地/国际层面进行监测对于及时给予适当的治疗是可取的。
从 2016 年至 2017 年在意大利伦巴第大区的 12 家医院进行的基于实验室的监测中收集了引起菌血症的真菌和抗真菌药敏谱的数据。分析了这种感染在 20 年内的趋势。
共评估了 1024 例血培养阳性。念珠菌血症的发生率逐渐增加至每 1000 次入院 1.46 次。最常见的菌种是白色念珠菌（52%），其次是近平滑念珠菌（15%）和光滑念珠菌（13%）。与之前的调查一样，抗真菌药物耐药性罕见（棘白菌素<2%，氟康唑 6%，两性霉素 B 0.6%）。18 例血培养阳性由非念珠菌真菌引起：新型隐球菌（5 例）、镰刀菌属（4 例）、枝顶孢属（3 例）、酿酒酵母（3 例）、罗伦隐球菌属（2 例）、皮炎外瓶霉（1 例）。除酿酒酵母外，所有真菌对棘白菌素均固有耐药。一些分离株也表现出较高的唑类 MIC 值。
在菌种分布和抗真菌药物敏感性方面没有观察到特别的变化。然而，需要进行监测计划来监测抗真菌药物耐药性的趋势，指导管理活动，指导经验性治疗。
