Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, 28007, Madrid, Spain.
Med Mycol. 2023 Jul 6;61(7). doi: 10.1093/mmy/myad072.
Several institutions reported a rise not only in fungemia incidence but also in the number of cases caused by Candida auris or fluconazole-resistant C. parapsilosis during the COVID-19 pandemic. Since the pandemic broke out in early 2020, we studied its impact on fungemia incidence, species epidemiology, potential patient-to-patient transmission, and antifungal resistance in 166 incident yeast isolates collected from January 2020 to December 2022. Isolates were molecularly identified, and their antifungal susceptibilities to amphotericin B, azoles, micafungin, anidulafungin, and ibrexafungerp were studied following the European Committee on Antimicrobial Susceptibility Testing (EUCAST) method, and genotyped. The fungemia incidence (episodes per 1000 admissions) tended to decrease over time (2020 = 1.60, 2021 = 1.36, 2022 = 1.16); P > .05). Species distribution was C. albicans (50.6%, n = 84), C. parapsilosis (18.7%, n = 31), C. glabrata (12.0%, n = 20), C. tropicalis (11.4%, n = 19), C. krusei (3.0%, n = 5), other Candida spp. (1.2%, n = 2), and non-Candida yeasts (3.0%, n = 5). The highest and lowest proportions of C. albicans and C. parapsilosis were detected in 2020. The proportion of isolates between 2020 and 2022 decreased in C. albicans (60.3% vs. 36.7%) and increased in C. parapsilosis (10.3% vs. 28.6%; P < .05) and C. tropicalis (8.8% vs. 16.3%; P > .05). Only three C. albicans intra-ward clusters involving two patients each were detected, and the percentages of patients involved in intra-ward clusters reached 9.8% and 8.0% in 2020 and 2021, respectively, suggesting that clonal spreading was not uncontrolled. Fluconazole resistance (5%) exhibited a decreasing trend (P > .05) over time (2020 = 7.6%; 2021 = 4.2%; and 2022 = 2.1%). Ibrexafungerp showed high in vitro activity.
在 COVID-19 大流行期间，许多机构报告称，不仅真菌感染的发病率上升，而且由耳念珠菌或氟康唑耐药近平滑念珠菌引起的病例数量也有所增加。自 2020 年初大流行爆发以来，我们研究了它对 2020 年至 2022 年 12 月期间从 166 例酵母分离株中收集的真菌血症发病率、种流行病学、潜在的患者间传播和抗真菌耐药性的影响。分离株进行了分子鉴定，并按照欧洲抗菌药物敏感性测试委员会 (EUCAST) 方法研究了它们对两性霉素 B、唑类药物、米卡芬净、阿尼达弗南和依布替尼的抗真菌敏感性，并进行了基因分型。真菌血症发病率（每 1000 例入院的病例数）随时间呈下降趋势（2020 年=1.60，2021 年=1.36，2022 年=1.16）；P>.05）。种分布为白色念珠菌（50.6%，n=84）、近平滑念珠菌（18.7%，n=31）、光滑念珠菌（12.0%，n=20）、热带念珠菌（11.4%，n=19）、克柔念珠菌（3.0%，n=5）、其他念珠菌属（1.2%，n=2）和非念珠菌酵母（3.0%，n=5）。2020 年检测到白色念珠菌和近平滑念珠菌的比例最高和最低。2020 年至 2022 年期间，白色念珠菌（60.3%对 36.7%）和近平滑念珠菌（10.3%对 28.6%；P<.05）和热带念珠菌（8.8%对 16.3%；P>.05）的分离株比例下降。仅检测到三个涉及每个病房两个患者的白色念珠菌病房内簇，2020 年和 2021 年涉及病房内簇的患者比例分别达到 9.8%和 8.0%，表明克隆传播未失控。氟康唑耐药（5%）呈下降趋势（P>.05），随时间推移（2020 年=7.6%；2021 年=4.2%；2022 年=2.1%）。依布替尼显示出体外高活性。
