Chen Pao-Yu, Chao Chien-Ming, Luo Chwan-Yau, Tseng Yau-Lin, Chen Po-Lin, Roan Jun-Neng, Liu Wei-Lun, Chu Chien, Wu Chi-Jung, Wang Hsuan-Chen, Hsieh Ming-I, Choi Pui-Ching, Chen Yee-Chun
Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
JAC Antimicrob Resist. 2024 Aug 29;6(4):dlae138. doi: 10.1093/jacamr/dlae138. eCollection 2024 Aug.
This study aimed to investigate the prevalence and characteristics of clinical and environmental isolates in Taiwan.
isolates obtained from patients at three hospitals and from 530 soil samples across Taiwan were screened. , confirmed by calmodulin sequencing, was subjected to antifungal susceptibility testing and analyses. Soil samples yielding were analysed for residues of 25 azole fungicides.
Nine isolates were identified, which included seven (1.2%, 7/601) isolates from three antifungal-naïve patients out of 601 section clinical isolates and two (0.3%, 2/659) isolates out of 659 soil isolates. All isolates developed white colonies and failed to grow at 48°C. They were susceptible to anidulafungin but showed reduced susceptibility to amphotericin B (AmB), voriconazole and azole fungicides. One heart transplant recipient with proven invasive pulmonary aspergillosis (IPA) initially showed suboptimal response to voriconazole monotherapy but was cured with a combination of voriconazole-caspofungin, liposomal AmB (LAmB)-caspofungin, along with surgery, followed by voriconazole maintenance therapy. Among two critically ill patients with probable IPA, one survived with micafungin, while the other died of aspergillosis despite sequential isavuconazole and LAmB monotherapy. Clinical and environmental isolates sharing identical Cyp51A sequence are identified, matching the Cyp51A sequence of NIID0096. Flusilazole (0.0009 mg/kg) was detected in one soil sample.
This study raises concerns about health threat posed by human pathogenic originating from natural environments and underscores the need for increased clinical and laboratory vigilance regarding infections.
本研究旨在调查台湾临床和环境分离株的流行情况及特征。
对从三家医院的患者以及台湾各地530份土壤样本中获得的分离株进行筛选。通过钙调蛋白测序确认后，对其进行抗真菌药敏试验和分析。对分离出该菌的土壤样本进行25种唑类杀菌剂残留分析。
共鉴定出9株该菌分离株，其中包括601份临床分离株中来自3例未接受过抗真菌治疗患者的7株（1.2%，7/601），以及659份土壤分离株中的2株（0.3%，2/659）。所有分离株均形成白色菌落，在48°C下无法生长。它们对阿尼芬净敏感，但对两性霉素B（AmB）、伏立康唑和唑类杀菌剂敏感性降低。一名确诊为侵袭性肺曲霉病（IPA）的心脏移植受者最初对伏立康唑单药治疗反应欠佳，但通过伏立康唑-卡泊芬净、脂质体AmB（LAmB）-卡泊芬净联合治疗，并结合手术，随后进行伏立康唑维持治疗而治愈。在两名疑似IPA的重症患者中，一名使用米卡芬净存活，而另一名尽管先后接受了艾沙康唑和LAmB单药治疗，仍死于曲霉病。鉴定出临床和环境分离株具有相同的Cyp51A序列，与NIID0096的Cyp51A序列匹配。在一份土壤样本中检测到氟硅唑（0.0009 mg/kg）。
本研究引发了对源自自然环境的人类致病性该菌所构成健康威胁的关注，并强调了在该菌感染方面加强临床和实验室监测的必要性。
