南非住院成人中光滑假丝酵母菌（以前称为念珠菌属）血流分离株的流行病学和易感性。

Epidemiology and susceptibility of Nakaseomyces (formerly Candida) glabrata bloodstream isolates from hospitalised adults in South Africa.

机构信息

Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.

School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

Med Mycol. 2023 Jun 5;61(6). doi: 10.1093/mmy/myad057.

DOI:10.1093/mmy/myad057

PMID:37336590

Abstract

During 2016-2017, Nakaseomyces glabrata (formerly Candida glabrata) caused 14% of cases of candidaemia in South Africa. We aimed to describe the clinical characteristics of adults with N. glabrata candidaemia at 20 sentinel hospitals (accounting for 20% (172/917) of cases) and the antifungal susceptibility of the corresponding isolates. A higher proportion of patients with N. glabrata candidaemia were older (median age: 55 years [interquartile range (IQR): 41-65 years] vs. 49 years [IQR: 35-63 years]; p = 0.04), female (87/164, 53% vs. 283/671, 42%; p = 0.01), admitted to a public-sector hospital (152/172, 88% vs. 470/745, 63%; p < 0.001), treated with fluconazole only (most with suboptimal doses) (51/95, 54% vs. 139/361, 39%; p < 0.001), and had surgery (47/172, 27% vs. 123/745, 17%; p = 0.001) and a shorter hospital stay (median 7 days [IQR: 2-20 days] vs. 13 days [IQR: 4-27 days]; p < 0.001) compared to patients with other causes of candidaemia. Eight N. glabrata isolates (6%, 8/131) had minimum inhibitory concentrations in the intermediate or resistant range for ≥ 1 echinocandin and a R1377K amino acid substitution encoded by the hotspot 2 region of the FKS2 gene. Only 11 isolates (8%, 11/131) were resistant to fluconazole. Patients with confirmed N. glabrata candidaemia are recommended to be treated with an echinocandin (or polyene), thus further guideline training is required.

摘要

在 2016 年至 2017 年期间，光滑念珠菌（以前称为念珠菌光滑）导致南非 14%的念珠菌血症病例。我们旨在描述 20 家监测医院（占 917 例病例的 20%（172/917））中成人光滑念珠菌血症患者的临床特征，以及相应分离株的抗真菌药敏性。光滑念珠菌血症患者中，年龄较大的患者比例较高（中位数年龄：55 岁[四分位距（IQR）：41-65 岁] vs. 49 岁[IQR：35-63 岁]；p=0.04），女性（87/164，53% vs. 283/671，42%；p=0.01），收入公立医院（152/172，88% vs. 470/745，63%；p<0.001），仅接受氟康唑治疗（大多数剂量不足）（51/95，54% vs. 139/361，39%；p<0.001），接受手术（47/172，27% vs. 123/745，17%；p=0.001）和住院时间较短（中位数 7 天[IQR：2-20 天] vs. 13 天[IQR：4-27 天]；p<0.001）与其他原因引起的念珠菌血症患者相比。8 株光滑念珠菌分离株（6%，8/131）的最小抑菌浓度在中间或耐药范围内，对棘白菌素的敏感性为 1≥，并且编码 FKS2 基因热点 2 区域的 R1377K 氨基酸取代。只有 11 株分离株（8%，11/131）对氟康唑耐药。建议确诊为光滑念珠菌血症的患者使用棘白菌素（或多烯）治疗，因此需要进一步的指南培训。