Clin Lab. 2022 Jun 1;68(6). doi: 10.7754/Clin.Lab.2021.211001.
The aim of the study was to investigate the Candida species distribution and their antifungal sensitivities, clinical characteristics, and risk factors of the critically ill patients with invasive Candida infections in a tertiary hospital.
Candida strains from critically ill patients were isolated in a tertiary hospital of Anhui Province from June 2019 to June 2020 through fungal cultures and identified with MALDI-TOF MS system. The antifungal susceptibility was measured by ATB Fungus-3 method. Demographic information and laboratory data were retrieved from the computerized hospital data system.
Candida albicans (C. albicans, 41.49%) was the predominant species in sterile body sites of critically ill patients developing invasive candidiasis, followed by C. glabrata (24.47%) and C. tropicalis (20.21%). The specimen sources were mainly urine (47.87%), then bronchoalveolar lavage fluid (18.09%) and blood (14.89%). In vitro, common Candida species were observed to be highly sensitive to amphotericin B and 5-fluorocytosine. All C. albicans exhibited susceptibility to both fluconazole and voriconazole, as did C. glabrata and C. parapsilosis. However, some C. tropicalis identified were frequently resistant to fluconazole, itraconazole, and voriconazole. The rate of Candida infection was positively correlated with certain risk factors including invasive interventions, age, length of stay in hospital, etc. Conclusions: C. albicans was the main species of invasive Candida infections in critically ill patients, followed by C. glabrata and C. tropicalis. Candida spp. showed the highest rate (10.60%) of resistance to fluconazole, followed by itraconazole (5.30%), voriconazole (5.30%), and 5-fluorocytosine (1.10%). All invasive Candida isolates were sensitive to amphotericin B. In addition, several C. tropicalis were tested and exhibited a high-level resistance to azoles. Notably, a variety of specific risk factors for candidiasis were identified in critically ill patients which need to be taken into consideration.
本研究旨在调查安徽省某三甲医院重症患者侵袭性念珠菌感染的念珠菌种类分布及其抗真菌药敏情况、临床特征和危险因素。
2019 年 6 月至 2020 年 6 月，通过真菌培养和 MALDI-TOF MS 系统从重症患者无菌部位分离念珠菌菌株。采用 ATB Fungus-3 法测定抗真菌药敏性。从计算机医院数据系统中检索人口统计学信息和实验室数据。
无菌部位念珠菌感染以白念珠菌（C. albicans，41.49%）为主，其次为近平滑念珠菌（C. glabrata，24.47%）和热带念珠菌（C. tropicalis，20.21%）。标本来源主要为尿液（47.87%），其次为支气管肺泡灌洗液（18.09%）和血液（14.89%）。体外常见念珠菌对两性霉素 B 和 5-氟胞嘧啶高度敏感。所有 C. albicans 对氟康唑和伏立康唑均敏感，C. glabrata 和 C. parapsilosis 也是如此。然而，一些鉴定为 C. tropicalis 的菌株对氟康唑、伊曲康唑和伏立康唑经常耐药。念珠菌感染率与侵袭性操作、年龄、住院时间等某些危险因素呈正相关。
C. albicans 是重症患者侵袭性念珠菌感染的主要菌种，其次是 C. glabrata 和 C. tropicalis。念珠菌对氟康唑的耐药率最高（10.60%），其次是伊曲康唑（5.30%）、伏立康唑（5.30%）和 5-氟胞嘧啶（1.10%）。所有侵袭性念珠菌分离株均对两性霉素 B 敏感。此外，一些 C. tropicalis 对唑类药物表现出高水平耐药性。值得注意的是，本研究还确定了重症患者中多种特定的念珠菌感染危险因素，需要加以考虑。
