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念珠菌血症患者中出现对抗真菌药物敏感性有限的隐性物种和物种复合体分支。

Emergence of cryptic species and clades of species complex exhibiting limited susceptibility to antifungals in patients with candidemia.

作者信息

Francisco Elaine Cristina, Ribeiro Felipe de Camargo, Almeida Junior João Nobrega, Pedoni Diego Betto, da Matta Daniel Archimedes, Dolande Maribel, Melo Analy Salles de Azevedo, Lima Ricardo Ferreira, Aquino Valério Rodrigues, Corzo-León Dora E, Zurita Jeannete, Cortes Jorge Alberto, Nucci Marcio, Colombo Arnaldo Lopes

机构信息

Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo , São Paulo, Brazil.

Department of Mycology, Instituto Nacional de Higiene Rafael Rangel , Caracas, Venezuela.

出版信息

Microbiol Spectr. 2023 Sep 12;11(5):e0511522. doi: 10.1128/spectrum.05115-22.

Abstract

Members of the species complex are able to cause superficial and life-threatening systemic infections with low susceptibility to azoles and echinocandins. We tested 130 bloodstream complex isolates collected from eight Latin American medical centers over 18 years (period 1 = 2000-2008 and period 2 = 2009-2018) to investigate trends in species distribution and antifungal resistance. The isolates were identified by rDNA ITS region sequencing, and antifungal susceptibility tests were performed against fluconazole, voriconazole, anidulafungin, and amphotericin B using the CLSI microbroth method. (s.s.; = 116) was the most prevalent species, followed by ( = 12) and ( = 2). Based on rDNA ITS identification, three clades within were characterized (clade 1 = 94; clade 2 = 19; and clade 3 = 3). In the second period of study, we found a substantial increment in the isolation of (3.4% versus 13.8%; = 0.06) and clade 2 s.s. exhibiting lower susceptibility to one or more triazoles. IMPORTANCE Yeast-invasive infections play a relevant role in human health, and there is a concern with the emergence of non- pathogens causing disease worldwide. There is a lack of studies addressing the prevalence and antifungal susceptibility of different species within the complex that cause invasive infections. We evaluated 130 episodes of species complex candidemia documented in eight medical centers over 18 years. We detected the emergence of less common species within the complex causing candidemia and described a new clade of with limited susceptibility to triazoles. These results support the relevance of continued global surveillance efforts to early detect, characterize, and report emergent fungal pathogens exhibiting limited susceptibility to antifungals.

摘要

该种复合体的成员能够引起表浅的和危及生命的全身感染,对唑类和棘白菌素类药物敏感性较低。我们检测了18年间从8个拉丁美洲医疗中心收集的130株血流复合体分离株(时期1 = 2000 - 2008年,时期2 = 2009 - 2018年),以调查物种分布和抗真菌耐药性的趋势。通过rDNA ITS区域测序鉴定分离株,并使用CLSI微量肉汤法对氟康唑、伏立康唑、阿尼芬净和两性霉素B进行抗真菌药敏试验。光滑念珠菌(光滑念珠菌;n = 116)是最常见的物种,其次是近平滑念珠菌(n = 12)和葡萄牙念珠菌(n = 2)。基于rDNA ITS鉴定,光滑念珠菌内的三个进化枝得以表征(进化枝1光滑念珠菌 = 94;进化枝2光滑念珠菌 = 19;进化枝3光滑念珠菌 = 3)。在研究的第二个时期,我们发现光滑念珠菌的分离率大幅增加(3.4%对13.8%;P = 0.06),并且进化枝2光滑念珠菌对一种或多种三唑类药物的敏感性较低。重要性酵母菌侵袭性感染在人类健康中发挥着重要作用,并且人们对全球范围内引起疾病的非白念珠菌病原体的出现表示关注。缺乏针对引起侵袭性感染的念珠菌复合体中不同物种的患病率和抗真菌药敏性的研究。我们评估了18年间在8个医疗中心记录的130例念珠菌复合体念珠菌血症病例。我们检测到念珠菌复合体中引起念珠菌血症的较不常见物种的出现,并描述了一个对三唑类药物敏感性有限的光滑念珠菌新进化枝。这些结果支持持续进行全球监测工作以早期检测、表征和报告对抗真菌药物敏感性有限的新兴真菌病原体的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c83c/10580822/96eb48e32443/spectrum.05115-22.f001.jpg

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