Clinical Microbiology Department, Children's Hospital Affiliated to Shandong University, Jinan, 250022, China; Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, China.
Laboratory Medicine, Hospital Affiliated to Binzhou Medical University, Binzhou, 256603, China.
Indian J Med Microbiol. 2024 Jan-Feb;47:100518. doi: 10.1016/j.ijmmb.2023.100518. Epub 2023 Dec 5.
We analyzed the pathogenic fungal epidemiology and antifungal susceptibility from 2018 to 2021 in Shandong Province, China, to provide the basis for empiric antifungal therapy.
Fungal isolates were collected from 54 hospitals in Shandong province from 2018 to 2021 through the Shandong Province Pediatric bacterial & fungal Antimicrobial Resistance Surveillance System (SPARSS), WHONET v5.6 and SPSS software v20.0 were used for statistical analysis.
A total of 15,348 strains of fungi were collected, with Candida accounting for 78.25 %, followed by Aspergillus at 15.45 %, and other species at 6.27 %. Candida albicans was the predominant Candida species, but more than half of the Candida isolates were non-albicans species, with C. tropicalis being the most dominant (22.74 %), followed by C. glabrata (17.50 %) and C. parapsilosis (11.02 %). The composition of fungi varied significantly among different age groups. Children had a higher proportion of C. albicans (47.30 %) compared to non-children (32.06 %). The non-wild-type phenotype rate of Candida for Amphotericin B was less than 3 %, while Cryptococcus neoformans was 16.67 %. In addition, less than 6 % of C. albicans and C. parapsilosis were resistant to fluconazole and voriconazole, and 96.30 % of C. glabrata were SDD to fluconazole. We also found that 80.56 % of C. glabrata and 83.70 % of C. krusei were voriconazole WT/susceptibility phenotype. However, the susceptibility rates of C. tropicalis to fluconazole/voriconazole decreased from 70.40 %/46.40 % in 2018 to 62.30 %/35.20 % in 2021. The comprehensive susceptibility rate to fluconazole of C. albicans, C. tropicalis, C. parapsilosis and C. glabrata isolated from the blood has decreased from 69.36 % to 56.62 %.
The study reveals that the composition and antifungal susceptibility of pathogenic fungi in Shandong Province differ from other regions. Moreover, the resistance to azoles is more severe, especially in C. tropicalis. These findings indicate the need for region-specific antifungal treatment strategies to combat fungal infections effectively.
分析 2018 年至 2021 年山东省的致病真菌流行病学和抗真菌药物敏感性，为经验性抗真菌治疗提供依据。
通过山东省儿科细菌和真菌抗菌药物耐药性监测系统（SPARSS），2018 年至 2021 年从山东省 54 家医院收集真菌分离株。使用 WHONET v5.6 和 SPSS 软件 v20.0 进行统计分析。
共收集真菌 15348 株，其中念珠菌占 78.25%，曲霉占 15.45%，其他菌种占 6.27%。白念珠菌是主要的念珠菌种，但超过一半的念珠菌分离株为非白念珠菌，其中热带念珠菌最常见（22.74%），其次是光滑念珠菌（17.50%）和近平滑念珠菌（11.02%）。不同年龄组的真菌构成差异显著。儿童的白念珠菌（47.30%）比例高于非儿童（32.06%）。两性霉素 B 的非野生型表型率低于 3%，而新型隐球菌为 16.67%。此外，氟康唑和伏立康唑耐药的白念珠菌和近平滑念珠菌不到 6%，氟康唑敏感的光滑念珠菌 96.30%。我们还发现，80.56%的光滑念珠菌和 83.70%的克柔念珠菌对伏立康唑为 WT/sus 表型。然而，2018 年至 2021 年，热带念珠菌对氟康唑/伏立康唑的敏感性率从 70.40%/46.40%降至 62.30%/35.20%。从血液中分离出的白念珠菌、热带念珠菌、近平滑念珠菌和光滑念珠菌对氟康唑的综合敏感性率从 69.36%降至 56.62%。
本研究表明，山东省致病真菌的组成和抗真菌药物敏感性与其他地区不同。而且，唑类药物的耐药性更为严重，尤其是热带念珠菌。这些发现表明需要制定针对特定地区的抗真菌治疗策略，以有效治疗真菌感染。
