上海地区临床分离念珠菌的耐药性监测

Surveillance of drug resistance of clinical Candida isolates in Shanghai

目的了解上海地区临床分离念珠菌的菌株分布以及对常用抗真菌药物的敏感性和耐药性。方法对上海地区27所医院临床分离念珠菌采用微量液基稀释法按统一方案进行抗真菌药物敏感性试验。按CLSI M60(2017年)判断结果。结果收集2017年8月1日-2018年4月30日上述医院临床分离念珠菌共354株,其中白念珠菌占41.81%(148/354),近平滑念珠菌占23.73%(84/354),热带念珠菌占15.54%(55/354),光滑念珠菌占9.32%(33/354),其他念珠菌占9.60%(34/354)。白念珠菌、近平滑念珠菌、光滑念珠菌耐药率与以往报道比较偏低或基本持平,无增长趋势,主要是对唑类抗真菌药物具有一定的耐药性。白念珠菌对氟康唑耐药率为1.45%、剂量依赖性敏感(SDD)率为4.35%,对伏立康唑耐药率和中介率均为2.17%;近平滑念珠菌对氟康唑呈现1.20%的SDD率,对伏立康唑呈现1.20%的中介率;光滑念珠菌对氟康唑表现出6.06%的耐药率和93.94%的SDD率;热带念珠菌耐药率呈增长趋势,对氟康唑表现出41.82%的耐药率和12.73%的SDD率,对伏立康唑表现出40.00%的耐药率和12.73%的中介率。白念珠菌、近平滑念珠菌、热带念珠菌对棘白菌素类药物尚未出现耐药菌株,仅1株光滑念珠菌对卡泊芬净耐药。结论上海地区临床念珠菌的分离率及菌株分布与国内外报道基本一致,临床分离菌株对常用抗菌药物的耐药率基本稳定,热带念珠菌对唑类抗真菌药物的耐药率呈上升趋势,应该引起临床医师重视。同时应进一步加强医院感染防控措施,继续做好真菌耐药性监测工作。

Objective To investigate the distribution and susceptibility of clinical Candida isolates in Shanghai.Methods Twenty-seven general hospitals in Shanghai were involved in this program.Antifungal susceptibility testing was carried out using broth microdilution method.Results were analyzed according to CLSI M60(2017).Results A total of 354 Candida isolates were collected between August 2017 and April 2018,of which Candida albicans,Candida parapsilosis,Candida tropicalis and Candida glabrata accounted for 41.81%,23.73%,15.54%and 9.32%,respectively.Candida albicans,Candida parapsilosis and Candida tropicalis isolates showed similar resistance rates as in previous reports,mainly due to their resistance to azole antifungal agents.The resistance rate of Candida albicans was 1.45%,and the susceptible-dose dependent(SDD)rate was 4.35%to fluconazole.Both the resistance rate and intermediate rate of Candida albicans to voriconazole were 2.17%.Both the SDD rate and intermediate rate of Candida parapsilosis isolates was 1.20%to fluconazole.About 6.06%of Candida glabrata strains were resistant to fluconazole and 93.94%were SDD to fluconazole.The resistance rates of Candida tropicalis to azole antifungal agents were on the rise,evidenced by 41.82%resistant and 12.73%SDD to fluconazole,40.00%resistant and 12.73%intermediate to voriconazole.In this study,Candida albicans,Candida parapsilosis and Candida tropicalis isolates were not resistant to echinocandins.Only one strain of Candida glabrata was resistant to caspofungin.Conclusions The prevalence and distribution of invasive Candida strains in Shanghai are essentially the same as other reports at home and abroad.The resistance rate of clinical isolates to common antifungal drugs is stable.Candida tropicalis ioslates show increasing resistance rate to azole antifungal drugs.It is necessary to strengthen control of hospital infection and management of clinical use of antifungal agents,as well as improve the surveilliance of fungal resistance.