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范式转变:作为从血流感染中分离出的最常见物种,唑类不敏感率不断上升:2015 - 2022年调查趋势

Paradigm Shift: as the Most Prevalent Species Isolated from Bloodstream Infections with Increasing Azole-Non-Susceptibility Rates: Trends from 2015-2022 Survey.

作者信息

Franconi Iacopo, Rizzato Cosmeri, Tavanti Arianna, Falcone Marco, Lupetti Antonella

机构信息

Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy.

Mycology Unit, Pisa University Hospital, 56126 Pisa, Italy.

出版信息

J Fungi (Basel). 2023 Oct 13;9(10):1012. doi: 10.3390/jof9101012.

Abstract

Candidemia is the fourth most common healthcare-related bloodstream infection. In recent years, incidence rates of have been on the rise, with differences in prevalence and antifungal susceptibility between countries. The aim of the present study was to evaluate temporal changes in prevalence and antifungal susceptibility of among other species causing candidemia. All candidemia episodes from January 2015 to August 2022 were evaluated in order to depict time trends in prevalence of among all species recovered from blood cultures as well as fluconazole- and voriconazole-non-susceptibility rates. Secondary analyses evaluated time trends in prevalence and antifungal non-susceptibility according to clinical settings. The overall prevalence of was observed to increase compared to the prevalence of other species over time (-trend = 0.0124). From 2019, the number of isolates surpassed , without an increase in incidence rates. Overall rates of fluconazole- and voriconazole-non-susceptible were both 3/44 (6.8%) in 2015 and were 32/51 (62.7%) and 27/51 (52.9%), respectively, in 2022 (85% cross-non-susceptibility). The risk of detecting fluconazole- or voriconazole-non-susceptibility was found to be higher in compared to other species (odds ratio (OR) = 1.60, 95% CI [1.170, 2.188], -value < 0.0001 and OR = 12.867, 95% CI [6.934, 23.878], -value < 0.0001, respectively). This is the first study to report as the most prevalent among spp. isolated from blood cultures, with worrisome fluconazole- and voriconazole-non-susceptibility rates, unparalleled among European and North American geographical regions.

摘要

念珠菌血症是第四常见的医疗相关血流感染。近年来,其发病率一直在上升,各国在患病率和抗真菌药敏性方面存在差异。本研究的目的是评估念珠菌血症致病菌种中念珠菌的患病率和抗真菌药敏性的时间变化。对2015年1月至2022年8月期间所有念珠菌血症发作进行评估,以描绘从血培养中分离出的所有念珠菌菌种中念珠菌的患病率以及氟康唑和伏立康唑不敏感率的时间趋势。二次分析根据临床环境评估患病率和抗真菌不敏感性的时间趋势。随着时间的推移,与其他念珠菌菌种的患病率相比,念珠菌的总体患病率有所增加(线性趋势=0.0124)。从2019年起,念珠菌分离株的数量超过了其他菌种,但发病率并未增加。2015年,氟康唑和伏立康唑不敏感的念珠菌总体发生率均为3/44(6.8%),2022年分别为32/51(62.7%)和27/51(52.9%)(交叉不敏感率为85%)。与其他念珠菌菌种相比,发现念珠菌检测到氟康唑或伏立康唑不敏感的风险更高(优势比(OR)=1.60,95%置信区间[1.170,2.188],P值<0.0001;OR=12.867,95%置信区间[6.934,23.878],P值<0.0001)。这是第一项报告念珠菌是血培养分离出的念珠菌属中最常见菌种的研究,其氟康唑和伏立康唑不敏感率令人担忧,在欧洲和北美地理区域中是无与伦比的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cac0/10608153/aa0bdec4ffda/jof-09-01012-g001.jpg

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