Pfaller M A, Jones R N, Doern G V, Sader H S, Hollis R J, Messer S A
Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
J Clin Microbiol. 1998 Jul;36(7):1886-9. doi: 10.1128/JCM.36.7.1886-1889.1998.
An international program of surveillance of bloodstream infections (BSIs) in the United States, Canada, and South America between January and December 1997 detected 306 episodes of candidemia in 34 medical centers (22 in the United States, 6 in Canada, and 6 in South America). Eighty percent of the BSIs were nosocomial and 50% occurred in patients hospitalized in an intensive care unit. Overall, 53.3% of the BSIs were due to Candida albicans, 15.7% were due to C. parapsilosis, 15.0% were due to C. glabrata, 7.8% were due to C. tropicalis, 2.0% were due to C. krusei, 0.7% were due to C. guilliermondii, and 5.8% were due to Candida spp. However, the distribution of species varied markedly by country. In the United States, 43.8% of BSIs were due to non-C. albicans species. C. glabrata was the most common non-C. albicans species in the United States. The proportion of non-C. albicans BSIs was slightly higher in Canada (47.5%), where C. parapsilosis, not C. glabrata, was the most common non-C. albicans species. C. albicans accounted for 40.5% of all BSIs in South America, followed by C. parapsilosis (38.1%) and C. tropicalis (11.9%). Only one BSI due to C. glabrata was observed in South American hospitals. Among the different species of Candida, resistance to fluconazole (MIC, > or = 64 microg/ml) and itraconazole (MIC, > or = 1.0 microg/ml) was observed with C. glabrata and C. krusei and was observed more rarely among other species. Isolates of C. albicans, C. parapsilosis, C. tropicalis, and C. guilliermondii were all highly susceptible to both fluconazole (99.4 to 100% susceptibility) and itraconazole (95.8 to 100% susceptibility). In contrast, 8.7% of C. glabrata isolates (MIC at which 90% of isolates are inhibited [MIC90], 32 microg/ml) and 100% of C. krusei isolates were resistant to fluconazole, and 36.9% of C. glabrata isolates (MIC90, 2.0 microg/ml) and 66.6% of C. krusei isolates were resistant to itraconazole. Within each species there were no geographic differences in susceptibility to fluconazole or itraconazole.
1997年1月至12月，在美国、加拿大和南美洲开展的一项关于血流感染（BSIs）的国际监测项目，在34个医疗中心（美国22个、加拿大6个、南美洲6个）检测到306例念珠菌血症病例。80%的血流感染为医院感染，其中50%发生在重症监护病房住院的患者中。总体而言，53.3%的血流感染由白色念珠菌引起，15.7%由近平滑念珠菌引起，15.0%由光滑念珠菌引起，7.8%由热带念珠菌引起，2.0%由克柔念珠菌引起，0.7%由季也蒙念珠菌引起，5.8%由念珠菌属引起。然而，念珠菌菌种的分布在不同国家有显著差异。在美国，43.8%的血流感染由非白色念珠菌引起。光滑念珠菌是美国最常见的非白色念珠菌。加拿大非白色念珠菌引起的血流感染比例略高（47.5%），其中最常见的非白色念珠菌是近平滑念珠菌，而非光滑念珠菌。在南美洲，白色念珠菌占所有血流感染的40.5%，其次是近平滑念珠菌（38.1%）和热带念珠菌（11.9%）。在南美洲医院仅观察到1例由光滑念珠菌引起的血流感染。在不同的念珠菌菌种中，光滑念珠菌和克柔念珠菌对氟康唑（最低抑菌浓度[MIC]≥64μg/ml）和伊曲康唑（MIC≥1.0μg/ml）表现出耐药性，而在其他菌种中较少见。白色念珠菌、近平滑念珠菌、热带念珠菌和季也蒙念珠菌的分离株对氟康唑（敏感性为９９.４%至100%）和伊曲康唑（敏感性为95.8%至100%）均高度敏感。相比之下，8.7%的光滑念珠菌分离株（90%菌株被抑制时的MIC[MIC90]为32μg/ml）和100%的克柔念珠菌分离株对氟康唑耐药，36.9%的光滑念珠菌分离株（MIC90为2.0μg/ml）和66.6%的克柔念珠菌分离株对伊曲康唑耐药。在每个菌种内，对氟康唑或伊曲康唑的敏感性不存在地理差异。
