Guo Jian, Zhang Min, Qiao Dan, Shen Hui, Wang Lili, Wang Dongjiang, Li Li, Liu Yun, Lu Huaiwei, Wang Chun, Ding Hui, Zhou Shuping, Zhou Wanqing, Wei Yingjue, Zhang Haomin, Xi Wei, Zheng Yi, Wang Yueling, Tang Rong, Zeng Lingbing, Xu Heping, Wu Wenjuan
Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Microbiol. 2021 Mar 4;12:644000. doi: 10.3389/fmicb.2021.644000. eCollection 2021.
complex is one of the most common non- species that cause candidemia, especially invasive candidiasis. The purpose of this study was to evaluate the antifungal susceptibilities of both colonized and invasive clinical complex isolates to 10 drugs: amphotericin (AMB), anidulafungin (AFG), caspofungin (CAS), micafungin (MFG), fluconazole (FLZ), voriconazole (VRZ), itraconazole (ITZ), posaconazole (POZ), 5-flucytosine (FCY), and isaconazole (ISA). In total, 884 species complex isolates were gathered between January 2005 and December 2020. , , and accounted for 86.3, 8.1, and 5.5% of the cryptic species, respectively. The resistance/non-wild-type rate of bloodstream to the drugs was 3.5%, of to AFG and CAS was 7.7%, and of to FLZ and VRZ was 15% and to CAS, MFG, and POZ was 5%. The geometric mean (GM) minimum inhibitory concentrations (MICs) of non-bloodstream for CAS (0.555 mg/L), MFG (0.853 mg/L), FLZ (0.816 mg/L), VRZ (0.017 mg/L), ITZ (0.076 mg/L), and POZ (0.042 mg/L) were significantly higher than those of bloodstream , for which the GM MICs were 0.464, 0.745, 0.704, 0.015, 0.061, and 0.033 mg/L, respectively ( < 0.05). The MIC distribution of the bloodstream strains collected from 2019 to 2020 for VRZ, POZ, and ITZ were 0.018, 0.040, and 0.073 mg/L, significantly higher than those from 2005 to 2018, which were 0.013, 0.028, and 0.052 mg/L ( < 0.05). Additionally, MIC distributions of with FLZ and the distributions of with ITZ and POZ might be higher than those in Clinical and Laboratory Standards Institute studies. Furthermore, a total of 143 complex isolates showed great susceptibility to ISA. Overall, antifungal treatment of the non-bloodstream complex isolates should be managed and improved. The clinicians are suggested to pay more attention on azoles usage for the complex isolates. In addition, establishing the epidemiological cutoff values (ECVs) for azoles used in Eastern China may offer better guidance for clinical treatments. Although ISA acts on the same target as other azoles, it may be used as an alternative therapy for cases caused by FLZ- or VRZ-resistant complex strains.
复合体是引起念珠菌血症最常见的非菌种之一，尤其是侵袭性念珠菌病。本研究的目的是评估定植和侵袭性临床复合体分离株对10种药物的抗真菌敏感性：两性霉素（AMB）、阿尼芬净（AFG）、卡泊芬净（CAS）、米卡芬净（MFG）、氟康唑（FLZ）、伏立康唑（VRZ）、伊曲康唑（ITZ）、泊沙康唑（POZ）、5-氟胞嘧啶（FCY）和艾沙康唑（ISA）。2005年1月至2020年12月期间共收集了884株复合体分离株。、和分别占隐匿菌种的86.3%、8.1%和5.5%。血流中对这些药物的耐药/非野生型率为3.5%，对AFG和CAS的耐药/非野生型率为7.7%，对FLZ和VRZ的耐药/非野生型率为15%，对CAS、MFG和POZ的耐药/非野生型率为5%。非血流中对CAS（0.555mg/L）、MFG（0.853mg/L）、FLZ（0.816mg/L）、VRZ（0.017mg/L）、ITZ（0.076mg/L）和POZ（0.042mg/L）的几何平均（GM）最低抑菌浓度（MIC）显著高于血流中的，其GM MIC分别为0.464、0.745、0.704、0.015、0.061和0.033mg/L（<0.05）。2019年至2020年收集的血流菌株对VRZ、POZ和ITZ的MIC分布分别为0.018、0.040和0.073mg/L，显著高于2005年至2018年的，分别为0.013、0.028和0.052mg/L（<0.05）。此外，对FLZ的MIC分布以及对ITZ和POZ的分布可能高于临床和实验室标准协会研究中的分布。此外，共有143株复合体分离株对ISA表现出高度敏感性。总体而言，非血流复合体分离株的抗真菌治疗应加以管理和改进。建议临床医生更多关注复合体分离株的唑类药物使用。此外，建立中国东部地区使用的唑类药物的流行病学临界值（ECV）可能为临床治疗提供更好的指导。尽管ISA与其他唑类作用于相同靶点，但它可作为由FLZ或VRZ耐药复合体菌株引起的病例的替代治疗药物。
