Parasitology and Mycology Department, Mustapha University Hospital, 16000, Algiers, Algeria.
Yeast Department, Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.
Antimicrob Resist Infect Control. 2020 Apr 7;9(1):50. doi: 10.1186/s13756-020-00710-z.
Despite being associated with a high mortality and economic burden, data regarding candidemia are scant in Algeria. The aim of this study was to unveil the epidemiology of candidemia in Algeria, evaluate the antifungal susceptibility pattern of causative agents and understand the molecular mechanisms of antifungal resistance where applicable. Furthermore, by performing environmental screening and microsatellite typing we sought to identify the source of infection.
We performed a retrospective epidemiological-based surveillance study and collected available blood yeast isolates recovered from the seven hospitals in Algiers. To identify the source of infection, we performed environmental screening from the hands of healthcare workers (HCWs) and high touch areas. Species identification was performed by API Auxa-Color and MALDI-TOF MS and ITS sequencing was performed for species not reliably identified by MALDI-TOF MS. Antifungal susceptibility testing followed CLSI M27-A3/S4 and included all blood and environmental yeast isolates. ERG11 sequencing was performed for azole-resistant Candida isolates. Microsatellite typing was performed for blood and environmental Candida species, where applicable.
Candida tropicalis (19/66) was the main cause of candidemia in these seven hospitals, followed by Candida parapsilosis (18/66), Candida albicans (18/66), and Candida glabrata (7/66). The overall mortality rate was 68.6% (35/51) and was 81.2% for C. tropicalis-infected patients (13/16). Fluconazole was the main antifungal drug used (12/51); 41% of the patients (21/51) did not receive any systemic treatment. Candida parapsilosis was isolated mainly from the hands of HCWs (7/28), and various yeasts were collected from high-touch areas (11/47), including Naganishia albida, C. parapsilosis and C. glabrata. Typing data revealed interhospital transmission on two occasions for C. parapsilosis and C. glabrata, and the same clone of C. parapsilosis infected two patients within the same hospital. Resistance was only noted for C. tropicalis against azoles (6/19) and fluconazole-resistant C. tropicalis isolates (≥8 μg/ml) (6/19) contained a novel P56S (5/6) amino acid substitution and a previously reported one (V234F; 1/6) in Erg11p.
Collectively, our data suggest an urgent need for antifungal stewardship and infection control strategies to improve the clinical outcome of Algerian patients with candidemia. The high prevalence of C. tropicalis joined by fluconazole-resistance may hamper the therapeutic efficacy of fluconazole, the frontline antifungal drug used in Algeria.
尽管念珠菌血症与高死亡率和经济负担相关，但在阿尔及利亚，有关念珠菌血症的数据仍然很少。本研究旨在揭示阿尔及利亚念珠菌血症的流行病学特征，评估致病真菌的抗真菌药敏模式，并了解抗真菌耐药的分子机制（如有）。此外，通过进行环境筛查和微卫星分型，我们试图确定感染源。
我们进行了一项回顾性基于流行病学的监测研究，并收集了来自阿尔及尔 7 家医院的可用血液酵母分离株。为了确定感染源，我们对医护人员（HCWs）的手部和高接触区域进行了环境筛查。通过 API Auxa-Color 和 MALDI-TOF MS 进行种属鉴定，对于 MALDI-TOF MS 不能可靠鉴定的种属进行 ITS 测序。按照 CLSI M27-A3/S4 进行抗真菌药敏试验，包括所有血液和环境酵母分离株。对唑类耐药的念珠菌分离株进行 ERG11 测序。对血液和环境念珠菌种属进行微卫星分型（如适用）。
在这 7 家医院中，热带念珠菌（19/66）是念珠菌血症的主要病因，其次是近平滑念珠菌（18/66）、白念珠菌（18/66）和光滑念珠菌（7/66）。总死亡率为 68.6%（35/51），热带念珠菌感染患者的死亡率为 81.2%（13/16）。氟康唑是使用的主要抗真菌药物（12/51）；41%的患者（21/51）未接受任何全身治疗。近平滑念珠菌主要从 HCWs 的手部分离（7/28），从高接触区域（11/47）收集了各种酵母，包括 Naganishia albida、近平滑念珠菌和光滑念珠菌。分型数据显示，两次医院间传播了近平滑念珠菌和光滑念珠菌，同一医院内 2 名患者感染了相同的近平滑念珠菌克隆。仅热带念珠菌对唑类药物（6/19）和氟康唑（≥8μg/ml）耐药，6 株氟康唑耐药热带念珠菌分离株（6/19）中，5 株含有 erg11p 中的新型 P56S（5/6）氨基酸取代和先前报道的一个（V234F；1/6）。
总之，我们的数据表明，迫切需要进行抗真菌药物管理和感染控制策略，以改善阿尔及利亚念珠菌血症患者的临床转归。高比例的热带念珠菌和氟康唑耐药可能会影响氟康唑的治疗效果，氟康唑是阿尔及利亚使用的一线抗真菌药物。
