Song Yinggai, Chen Xianlian, Yan Yan, Wan Zhe, Liu Wei, Li Ruoyu
Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.
Research Center for Medical Mycology, Peking University, Beijing, China.
Front Microbiol. 2020 Jul 3;11:1401. doi: 10.3389/fmicb.2020.01401. eCollection 2020.
To determine the dynamic changes of pathogenic yeast prevalence and antifungal susceptibility patterns in tertiary hospitals in China, we analyzed 527 yeast isolates preserved in the Research Center for Medical Mycology at Peking University, Beijing, China, between Jan 2010 and Dec 2019 and correctly identified 19 yeast species by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and ribosomal DNA sequencing. Antifungal susceptibility testing was performed following a Sensititre YeastOne colorimetric microdilution panel with nine clinically available antifungals. The Clinical and Laboratory Standards Institute (CLSI)-approved standard M27-A3 (S4) and newly revised clinical breakpoints or species-specific and method-specific epidemiological cutoff values were used for the interpretation of susceptibility test data. In this study, although was the predominant single species, non- species constituted >50% of isolates in 6 out of 10 years, and more rare species were present in the recent 5 years. The non- species identified most frequently were , , and . The prevalence of fluconazole and voriconazole resistance in the population was <3%, but exhibited decreased susceptibility to fluconazole (42, 57.5%) and voriconazole (31, 42.5%), and 22 (30.1%) isolates exhibited wild-type minimum inhibitory concentrations (MICs) to posaconazole. Furthermore, fluconazole and voriconazole cross-resistance prevalence in was 19 (26.1%). The overall prevalence of fluconazole resistance in the population was 14 (26.9%), and prevalence of isolates exhibiting voriconazole non-wild-type MICs was 33 (63.5%). High-level echinocandin resistance was mainly observed in , and the prevalence rates of isolate resistance to anidulafungin, micafungin, and caspofungin were 5 (9.6%), 5 (9.6%), and 4 (7.7%), respectively. Moreover, one isolate showed multidrug resistant to azoles, echinocandins, and flucytosine. Overall, the 10-year surveillance study showed the increasing prevalence of non- species over time; the emergence of azole resistance in and multidrug resistance in over the years reinforced the need for epidemiological surveillance and monitoring.
为确定中国三级医院致病性酵母的流行情况及抗真菌药敏模式的动态变化，我们分析了2010年1月至2019年12月间保存在中国北京北京大学医学真菌研究中心的527株酵母分离株，并通过基质辅助激光解吸电离飞行时间质谱（MALDI-TOF-MS）和核糖体DNA测序正确鉴定出19种酵母。采用含9种临床可用抗真菌药物的Sensititre YeastOne比色微量稀释板进行抗真菌药敏试验。采用临床和实验室标准协会（CLSI）批准的标准M27-A3（S4）以及新修订的临床折点或特定菌种和特定方法的流行病学临界值来解释药敏试验数据。在本研究中，尽管[某菌种]是主要的单一菌种，但在10年中的6年里，非[该菌种]构成了分离株的>50%，且在最近5年中出现了更多罕见菌种。最常鉴定出的非[该菌种]为[具体菌种1]、[具体菌种2]和[具体菌种3]。[某菌种]群体中氟康唑和伏立康唑耐药率<3%，但[另一菌种]对氟康唑（42株，57.5%）和伏立康唑（31株，42.5%）的敏感性降低，22株（30.1%）[该菌种]分离株对泊沙康唑表现出野生型最低抑菌浓度（MIC）。此外，[该菌种]中氟康唑和伏立康唑交叉耐药率为19株（26.1%）。[某菌种]群体中氟康唑耐药的总体发生率为14株（26.9%），表现出伏立康唑非野生型MIC的分离株发生率为33株（63.5%）。高水平棘白菌素耐药主要见于[某菌种]，分离株对阿尼芬净、米卡芬净和卡泊芬净的耐药率分别为5株（9.6%）、5株（9.6%）和4株（7.7%）。此外，1株[该菌种]分离株对唑类、棘白菌素类和氟胞嘧啶表现出多重耐药。总体而言，这项为期10年的监测研究表明，非[某菌种]的流行率随时间增加；多年来[某菌种]中唑类耐药的出现以及[另一菌种]中多重耐药的出现强化了进行流行病学监测的必要性。
