Nguyen M H, Peacock J E, Morris A J, Tanner D C, Nguyen M L, Snydman D R, Wagener M M, Rinaldi M G, Yu V L
University of Pittsburgh, Pennsylvania, USA.
Am J Med. 1996 Jun;100(6):617-23. doi: 10.1016/s0002-9343(95)00010-0.
To assess the changing epidemiology of candidemia in the 1990s, to evaluate the clinical implications for the presence of non-Candida albicans in blood, and to evaluate the presence of antifungal resistance in relation to prior antifungal administration.
Multicenter prospective observational study of patients with positive blood cultures for Candida species or Torulopsis glabrata.
Four tertiary care medical centers.
Four hundred twenty-seven consecutive patients were enrolled. The frequency of candidemia due to non-C. albicans species significantly increased in each hospital throughout the 3.5-year study period (P = 0.01). Thirteen percent of candidemias occurred in patients who were already receiving systemic antifungal agents. Candidemias developing while receiving antifungal therapy were more likely caused by non-C. albicans species than by C. albicans species (P = 0.0005). C. parapsilosis and C. krusei were more commonly seen with prior fluconazole therapy, whereas T. glabrata was more commonly seen with prior amphotericin B therapy. Candida species isolated during episodes of breakthrough candidemia exhibited a significantly higher MIC to the antifungal agent being administered (P < 0.001).
In this large scale study, the non-C. albicans species, especially T. glabrata, emerged as important and frequent pathogens causing fungemia. This finding has major clinical implications given the higher complication and mortality rate associated with the non-C. albicans species. The change in the pattern of candidemia might be partly attributed to the increase in number of immunocompromised hosts and the widespread use of prophylactic or empiric antifungal therapy. This is an ominous sign given the in vitro resistance of the non-C. albicans species to currently available antifungal agents.
评估20世纪90年代念珠菌血症流行病学的变化，评估血液中出现非白色念珠菌的临床意义，并评估与先前抗真菌治疗相关的抗真菌耐药性情况。
对念珠菌属或光滑球拟酵母菌血培养阳性患者进行的多中心前瞻性观察研究。
四家三级医疗中心。
连续纳入427例患者。在整个3.5年的研究期间，各医院中由非白色念珠菌引起的念珠菌血症发生率显著增加（P = 0.01）。13%的念珠菌血症发生在已接受全身性抗真菌药物治疗的患者中。接受抗真菌治疗时发生的念珠菌血症更可能由非白色念珠菌引起，而非白色念珠菌引起的念珠菌血症比白色念珠菌引起的念珠菌血症更常见（P = 0.0005）。近平滑念珠菌和克柔念珠菌在先前使用氟康唑治疗的患者中更常见，而光滑球拟酵母菌在先前使用两性霉素B治疗的患者中更常见。突破性念珠菌血症发作期间分离出的念珠菌属对正在使用的抗真菌药物的最低抑菌浓度显著更高（P < 0.001）。
在这项大规模研究中，非白色念珠菌，尤其是光滑球拟酵母菌，成为引起真菌血症的重要且常见的病原体。鉴于非白色念珠菌相关的更高并发症和死亡率，这一发现具有重大临床意义。念珠菌血症模式的变化可能部分归因于免疫受损宿主数量的增加以及预防性或经验性抗真菌治疗的广泛使用。鉴于非白色念珠菌对现有抗真菌药物的体外耐药性，这是一个不祥之兆。
