Arastehfar Amir, Hilmioğlu-Polat Suleyha, Daneshnia Farnaz, Pan Weihua, Hafez Ahmed, Fang Wenjie, Liao Wanqing, Şahbudak-Bal Zümrüt, Metin Dilek Yeşim, Júnior João N de Almeida, Ilkit Macit, Perlin David S, Lass-Flörl Cornelia
Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, United States.
Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Ege, Izmir, Turkey.
Front Cell Infect Microbiol. 2021 Apr 22;11:676177. doi: 10.3389/fcimb.2021.676177. eCollection 2021.
As the second leading etiological agent of candidemia in Turkey and the cause of severe fluconazole-non-susceptible (FNS) clonal outbreaks, emerged as a major health threat at Ege University Hospital (EUH). Evaluation of microbiological and pertinent clinical profiles of candidemia patients due to . in EUH in 2019-2020. isolates were collected from blood samples and identified by sequencing internal transcribed spacer ribosomal DNA. Antifungal susceptibility testing was performed in accordance with CLSI M60 protocol and and HS1/HS2- were sequenced to explore the fluconazole and echinocandin resistance, respectively. Isolates were typed using a multilocus microsatellite typing assay. Relevant clinical data were obtained for patients recruited in the current study. FNS . isolates were recovered from 53% of the patients admitted to EUH in 2019-2020. Y132F was the most frequent mutation in Erg11. All patients infected with . isolates carrying Y132F, who received fluconazole showed therapeutic failure and significantly had a higher mortality than those infected with other FNS and susceptible isolates (50% . 16.1%). All isolates carrying Y132F grouped into one major cluster and mainly recovered from patients admitted to chest diseases and pediatric surgery wards. The unprecedented increase in the number of Y132F . , which corresponded with increased rates of fluconazole therapeutic failure and mortality, is worrisome and highlights the urgency for strict infection control strategies, antifungal stewardship, and environmental screening in EUH.
作为土耳其念珠菌血症的第二大主要病原体以及严重氟康唑不敏感（FNS）克隆爆发的原因，在伊兹密尔埃杰大学医院（EUH）成为了一项重大的健康威胁。对2019 - 2020年期间EUH因该病原体导致念珠菌血症患者的微生物学和相关临床特征进行评估。从血样中收集该病原体分离株，并通过对核糖体DNA内部转录间隔区进行测序来鉴定。按照CLSI M60协议进行抗真菌药敏试验，并分别对该病原体的 和HS1/HS₂ - 进行测序以探究氟康唑和棘白菌素耐药性。使用多位点微卫星分型分析法对分离株进行分型。获取了本研究中招募患者的相关临床数据。2019 - 2020年在EUH住院的患者中，53%分离出FNS该病原体分离株。Y132F是Erg11中最常见的突变。所有感染携带Y132F该病原体分离株且接受氟康唑治疗的患者均显示治疗失败，并且其死亡率显著高于感染其他FNS和敏感分离株的患者（50%对16.1%）。所有携带Y132F的分离株聚为一个主要簇群，主要从肺病科和小儿外科病房收治的患者中分离得到。Y132F该病原体分离株数量前所未有的增加，这与氟康唑治疗失败率和死亡率的上升相对应，令人担忧，并凸显了在EUH实施严格感染控制策略、抗真菌管理和环境筛查的紧迫性。
