Chesdachai Supavit, Yetmar Zachary A, Ranganath Nischal, Everson Jenna J, Wengenack Nancy L, Abu Saleh Omar M
Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
J Fungi (Basel). 2023 Aug 3;9(8):821. doi: 10.3390/jof9080821.
The prevalence of invasive candidiasis caused by non- has rapidly increased. () is an important pathogen associated with substantial mortality. Our study examined the antifungal temporal susceptibility of and cross-resistance/non-wild-type patterns with other azoles and echinocandins. Laboratory data of all adult patients with isolated from clinical specimens at the Mayo Clinic, Rochester, from 2012 to 2022 were collected. Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints were used. We obtained 1046 isolates from 877 patients. Using CLSI and EUCAST breakpoints, 187 (17.9%) isolates and 256 (24.5%) isolates were fluconazole-resistant, respectively. Focusing on bloodstream infections, fluconazole-resistance ranged from 16 to 22%. Among those 187 fluconazole-resistant isolates, 187 (100%) and 184 (98.4%) isolates were also voriconazole and posaconazole non-wild-type, respectively, with 97 (51.9%) isolates deemed non-wild type for itraconazole. The fluconazole susceptibility pattern has not changed over the past decade. The proportion of fluconazole-resistant is relatively high, which could be due to the complexity of patients and fluconazole exposure. Itraconazole appears to be a compelling step-down therapy for fluconazole-resistant , given the high proportion of wild-type isolates. Further research to examine clinical outcomes is warranted.
由非（此处原文缺失相关内容）引起的侵袭性念珠菌病的患病率迅速上升。（此处原文缺失相关内容）是一种与高死亡率相关的重要病原体。我们的研究检测了（此处原文缺失相关内容）的抗真菌时间敏感性以及与其他唑类和棘白菌素的交叉耐药/非野生型模式。收集了2012年至2022年在罗切斯特梅奥诊所从临床标本中分离出（此处原文缺失相关内容）的所有成年患者的实验室数据。使用了临床和实验室标准协会（CLSI）以及欧洲抗菌药物敏感性试验委员会（EUCAST）的断点值。我们从877名患者中获得了1046株（此处原文缺失相关内容）分离株。使用CLSI和EUCAST断点值，分别有187株（17.9%）和256株（24.5%）分离株对氟康唑耐药。聚焦于（此处原文缺失相关内容）血流感染，氟康唑耐药率在16%至22%之间。在这187株氟康唑耐药分离株中，分别有187株（100%）和184株（98.4%）对伏立康唑和泊沙康唑呈非野生型，97株（51.9%）对伊曲康唑呈非野生型。在过去十年中，氟康唑的药敏模式没有变化。氟康唑耐药的（此处原文缺失相关内容）比例相对较高，这可能是由于患者情况复杂以及氟康唑暴露所致。鉴于野生型分离株比例较高，伊曲康唑似乎是针对氟康唑耐药（此处原文缺失相关内容）的一种有吸引力的降阶梯治疗药物。有必要进一步研究以检验临床结果。
