2018-2023 年中国西南地区妇女儿童医院分离的酿酒酵母分布及药敏情况。

Isolate distribution and antifungal susceptibility of Saccharomyces cerevisiae in the national regional medical center of Southwest China for women and children during 2018-2023.

机构信息

Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, China.

West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.

出版信息

BMC Microbiol. 2024 Sep 14;24(1):345. doi: 10.1186/s12866-024-03506-y.

DOI:10.1186/s12866-024-03506-y

PMID:39271978

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11401246/

Abstract

BACKGROUND

Saccharomyces cerevisiae has been considered a harmless yeast, but in recent years, increasing evidence has shown that it can cause disease in humans, especially invasive infections in infants/children and vulvovaginal infections in women. This study aimed to investigate the clinical information and antifungal susceptibility of clinical cases with S. cerevisiae and establish a foundation for the prevention and treatment of fungal infections.

METHODS

This study was conducted from May 2018 to May 2023 at a national regional medical center in Southwest China for women and children. The demographic and clinical characteristics of patients isolated with S. cerevisiae were collected and analyzed. All the isolates were cultured on Sabouraud medium plates and identified by MALDI-TOF MS. The antifungal susceptibility of S. cerevisiae to 10 agents (amphotericin B, fluconazole, itraconazole, voriconazole, micafungin, caspofungin, terbinafine and 5-flucytosine) was determined via the microdilution broth method to determine the minimum inhibitory concentrations (MICs).

RESULTS

A total of 75 cases of S. cerevisiae isolated from patients with vulvovaginal candidiasis (VVC, 44 cases), pneumonia (13 cases), or diarrhea (18 cases) were included after data review. The MICs of voriconazole and flucytosine for S. cerevisiae isolated from different body sites differed, with higher resistance in intestinal isolates. In this study, S. cerevisiae caused VVC, but there was no clear evidence that it was involved in pneumonia or diarrhea. Compared with those of Candida albicans, the primary pathogen of VVC, the MICs of fluconazole (11.96 ± 5.78 µg/mL vs. 67.64 ± 16.62 µg/mL, p = 0.002), itraconazole (0.77 ± 0.19 µg/mL vs. 2.31 ± 0.53 µg/mL, p = 0.008), voriconazole (0.22 ± 0.09 µg/mL vs. 5.02 ± 1.09 µg/mL, p < 0.001), and terbinafine (10.41 ± 0.84 µg/mL vs. 14.93 ± 4.77 µg/mL, p < 0.001) for S. cerevisiae (isolated from the genital tract) were significantly lower, while those of micafungin (0.14 ± 0.01 µg/mL vs. 0.06 ± 0.01 µg/mL, p < 0.001) and caspofungin (0.27 ± 0.04 µg/mL vs. 0.06 ± 0.01 µg/mL, p < 0.001) were significantly greater.

CONCLUSION

Azoles remain the recommended regimen for S. cerevisiae-related VVC, and the use of amphotericin B vaginal effervescent tablets could be considered for the treatment of azole-resistant isolates. The antifungal susceptibility of S. cerevisiae varies according to the isolated source, and the pathogenicity trend of S. cerevisiae should be studied.

摘要

背景

酿酒酵母一直被认为是一种无害的酵母，但近年来，越来越多的证据表明它会导致人类患病，特别是婴幼儿侵袭性感染和女性阴道感染。本研究旨在调查临床病例中酿酒酵母的临床信息和抗真菌药敏性，为真菌感染的预防和治疗奠定基础。

方法

本研究于 2018 年 5 月至 2023 年 5 月在西南地区一家全国性区域妇女儿童医学中心进行。收集并分析了分离出酿酒酵母的患者的人口统计学和临床特征。所有分离株均在沙氏琼脂平板上培养，并通过 MALDI-TOF MS 进行鉴定。采用微量稀释肉汤法测定酿酒酵母对 10 种药物（两性霉素 B、氟康唑、伊曲康唑、伏立康唑、米卡芬净、卡泊芬净、特比萘芬和 5-氟胞嘧啶）的药敏性，以确定最小抑菌浓度（MICs）。

结果

本研究共纳入 75 例来自阴道假丝酵母菌病（VVC，44 例）、肺炎（13 例）或腹泻（18 例）患者的酿酒酵母分离株。来自不同部位的酿酒酵母对伏立康唑和氟胞嘧啶的 MIC 不同，肠道分离株的耐药性更高。本研究中，酿酒酵母引起 VVC，但没有明确证据表明其与肺炎或腹泻有关。与 VVC 的主要病原体白假丝酵母菌相比，氟康唑（11.96 ± 5.78 µg/mL 比 67.64 ± 16.62 µg/mL，p=0.002）、伊曲康唑（0.77 ± 0.19 µg/mL 比 2.31 ± 0.53 µg/mL，p=0.008）、伏立康唑（0.22 ± 0.09 µg/mL 比 5.02 ± 1.09 µg/mL，p<0.001）和特比萘芬（10.41 ± 0.84 µg/mL 比 14.93 ± 4.77 µg/mL，p<0.001）对酿酒酵母（生殖道分离株）的 MIC 明显降低，而米卡芬净（0.14 ± 0.01 µg/mL 比 0.06 ± 0.01 µg/mL，p<0.001）和卡泊芬净（0.27 ± 0.04 µg/mL 比 0.06 ± 0.01 µg/mL，p<0.001）的 MIC 明显升高。