Escribano Pilar, Guinea Jesús
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Front Fungal Biol. 2022 Oct 24;3:1010782. doi: 10.3389/ffunb.2022.1010782. eCollection 2022.
is a leading cause of invasive candidiasis in southern Europe, Latin America and Asia. has been mostly considered susceptible to triazoles, but fluconazole resistance is on the rise in some countries. The main mechanism related to fluconazole resistance is the presence of ERG11p substitutions, dominated by the Y132F amino acid substitution. Isolates harbouring this substitution mimic given that they may cause hospital outbreaks, become endemic, and emerge simultaneously in distant areas around the world. At the moment, Spain is experiencing a brusque emergence of fluconazole resistance in ; isolates harbouring the Y132F substitution were detected for the first time in 2019. A recent study on spp isolates from blood cultures collected in 16 hospitals located in the Madrid metropolitan area (2019 to 2021) reported that fluconazole resistance in reached as high as 13.6%. Resistance rates rose significantly during those three years: 3.8% in 2019, 5.7% in 2020, and 29.1% in 2021; resistant isolates harboured either the dominant Y132F substitution (a single clone found in four hospitals) or G458S (another clone found in a fifth hospital). The COVID-19 pandemic may have increased the number of candidaemia cases. The reason for such an increase might be a consequence of uncontrolled intra-hospital patient-to-patient transmission in some hospitals, as an increase not only in candidaemia episodes but also in the spread of clonal fluconazole-resistant isolates might have occurred in other hospitals during the pandemic period. Patients affected with fluconazole-resistant harbouring the Y132F substitution presented a mortality rate ranging from 9% to 78%, were mainly admitted to intensive care wards but did not have differential risk factors compared to those infected by susceptible isolates. With scarce exceptions, few patients (≤20%) infected with fluconazole-resistant isolates had previously received fluconazole, thus supporting the fact that, although fluconazole might have been a key factor to promote resistance, the main driver promoting the spread of fluconazole-resistant isolates was patient-to-patient transmission.
在欧洲南部、拉丁美洲和亚洲，是侵袭性念珠菌病的主要病因。一直以来大多被认为对三唑类药物敏感，但在一些国家，氟康唑耐药性正在上升。与氟康唑耐药性相关的主要机制是存在ERG11p替代，以Y132F氨基酸替代为主。携带这种替代的分离株具有相似性，因为它们可能导致医院暴发、成为地方病，并在世界各地的遥远地区同时出现。目前，西班牙正经历着氟康唑耐药性在（此处原文缺失具体所指内容）中的突然出现；携带Y132F替代的分离株于2019年首次被检测到。最近一项对位于马德里大都会区的16家医院（2019年至2021年）收集的血培养中的（此处原文缺失具体所指内容）分离株的研究报告称，（此处原文缺失具体所指内容）中的氟康唑耐药性高达13.6%。在这三年中耐药率显著上升：2019年为3.8%，2020年为5.7%，2021年为29.1%；耐药分离株携带主要的Y132F替代（在四家医院发现的单个克隆）或G458S（在第五家医院发现的另一个克隆）。COVID-19大流行可能增加了念珠菌血症病例的数量。这种增加的原因可能是一些医院内患者之间不受控制的传播的结果，因为在大流行期间，其他医院不仅念珠菌血症发作增加，而且克隆性氟康唑耐药分离株的传播也可能发生。携带Y132F替代的氟康唑耐药（此处原文缺失具体所指内容）感染患者的死亡率在9%至78%之间，主要入住重症监护病房，但与易感分离株感染的患者相比没有差异风险因素。除了极少数例外情况，很少有（≤20%）感染氟康唑耐药分离株的患者之前接受过氟康唑治疗，因此支持了这样一个事实，即尽管氟康唑可能是促进耐药性的一个关键因素，但促进氟康唑耐药分离株传播的主要驱动因素是患者之间的传播。
