Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
Clin Microbiol Infect. 2023 Dec;29(12):1604.e1-1604.e6. doi: 10.1016/j.cmi.2023.08.021. Epub 2023 Aug 26.
Antifungal susceptibility testing is mostly conducted on blood-cultured Candida spp isolates. Because the intra-abdominal cavity has been highlighted as a hidden echinocandin-resistant C. glabrata reservoir, we assessed whether testing sequential isolates from a given patient might increase the chances of detecting antifungal resistance.
Intra-abdominal initial and sequential isolates from the same species from patients included in the CANDIdaemia in MADrid study (January 2019 to June 2022) were studied. We assessed antifungal susceptibility to amphotericin B, azoles, anidulafungin, micafungin, and ibrexafungerp using European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology and molecularly characterized resistant isolates.
We collected 308 isolates (C. albicans [n = 179/308; 58.1%], C. glabrata [n = 101/308; 32.8%], C. tropicalis [n = 17/308; 5.5%], and C. parapsilosis [n = 11/308; 3.6%]) from 112 patients distributed as incident (n = 125/308) and sequential (n = 183/308). Per patient resistance rates of fluconazole (13.4% [15/112] vs. 8% [9/112]); 5.4% proportions difference (95% CI, -2.7% to 13.5%, p 0.09) and echinocandins (8.9% [10/112] vs. 1.8% [2/112]); 7.1% proportions difference (95% CI; 1.2-12.9%; p 0.01) were higher when considering all available isolates than only incident isolates. Resistance was detected in 18 of 112 patients and would have been overlooked in 11 of 18 (61.1%) patients if only incident isolates had been studied. Of the patients who harboured fluconazole or echinocandin-resistant isolates, 14 of 15 and 8 of 10 had received or were receiving fluconazole or echinocandins, respectively.
Testing sequential Candida isolates from intra-abdominal samples is required to detect antifungal resistance, particularly to echinocandins, in patients whose incident isolates turned out to be susceptible. Furthermore, patients with echinocandin-resistant infections had frequently used echinocandins and had common secondary resistance acquisition.
抗真菌药敏试验主要针对血培养分离的念珠菌属进行。由于腹腔内已被确定为隐藏的棘白菌素耐药近平滑念珠菌库，我们评估了连续检测同一患者的分离株是否会增加检测到抗真菌耐药性的机会。
研究了 2019 年 1 月至 2022 年 6 月期间马德里念珠菌血症研究（CANDIdaemia in MADrid study）中纳入的患者的初始腹腔内和连续分离株。我们使用欧洲抗菌药物敏感性试验委员会（EUCAST）方法和分子特征分析对两性霉素 B、唑类、阿尼达弗林、米卡芬净和伊布康唑进行了抗真菌药敏试验。
我们从 112 名患者中收集了 308 株分离株（白色念珠菌[n=179/308；58.1%]、光滑念珠菌[n=101/308；32.8%]、热带念珠菌[n=17/308；5.5%]和近平滑念珠菌[n=11/308；3.6%]），这些患者分为首发（n=125/308）和连续（n=183/308）。氟康唑（13.4%[15/112] vs. 8%[9/112]）和棘白菌素（8.9%[10/112] vs. 1.8%[2/112]）的每位患者耐药率，差异为 5.4%（95%CI，-2.7%至 13.5%，p=0.09）和 7.1%（95%CI，1.2-12.9%；p=0.01），这在考虑所有可用分离株时高于仅考虑首发分离株时。如果仅研究首发分离株，18 名患者中有 18 名（61.1%）会检测到耐药，11 名患者（61.1%）的耐药情况会被忽视。在携带氟康唑或棘白菌素耐药分离株的患者中，15 名中有 14 名（87.5%）和 10 名中有 8 名（80.0%）分别接受或正在接受氟康唑或棘白菌素治疗。
需要对腹腔内样本的连续念珠菌分离株进行检测，以检测抗真菌耐药性，特别是对首发分离株敏感的患者的棘白菌素耐药性。此外，棘白菌素耐药感染患者经常使用棘白菌素，且经常获得继发耐药。
