全国7所儿童医院临床分离真菌耐药性监测

Surveillance of antifungal resistance in 7 children’s hospitals across China

目的分析儿童临床分离真菌的分布及耐药性,促进儿童临床抗真菌药物的合理选择。方法对国内7所儿童医院临床无菌体液分离的真菌,采用肉汤微量稀释法进行抗真菌药物敏感性试验,按CLSI和EUCAST标准判断药敏结果。结果2016年1月1日-2018年12月31日共获临床无菌体液分离真菌199株,以念珠菌为主,包括近平滑念珠菌36.2%、白念珠菌28.1%、热带念珠菌13.6%、光滑念珠菌4.0%。近平滑念珠菌对氟康唑的耐药率为4.0%,白念珠菌对氟康唑的耐药率为8.7%,热带念珠菌对氟康唑和伏立康唑的耐药率高达37.5%。热带念珠菌的分离率及其对氟康唑的耐药率在逐年增加,其他念珠菌的耐药率基本稳定。结论热带念珠菌对唑类抗真菌药物的耐药率呈上升趋势。对侵袭性真菌感染的预防和经验抗真菌治疗,应首选卡泊芬净等棘白菌素类药物。临床需要继续做好真菌耐药性监测工作。

Objective To analyze the distribution and resistance profile of clinical fungal strains isolated from children for rational antifungal therapy.Methods The fungal strains were isolated from children in 7 children’s hospitals across China.Antifungal susceptibility testing was carried out by microdilution method.The results were interpreted according to the CLSI and EUCAST breakpoints.Results A total of 199 fungal strains were collected from January 1,2016 to December 31,2018,including Candida parapsilosis(36.2%),Candida albicans(28.1%),Candida tropicalis(13.6%)and Candida glabrata(4.0%).About 4.0%of the C.parapsilosis strains were resistant to fluconazole,8.7%of C.albicans strains were resistant to fluconazole,and 37.5%of the C.tropicalis strains were resistant to fluconazole and voriconazole.The prevalence of C.tropicalis increased from 2016 to 2018 associated with increasing resistance rate to fluconazole.The susceptibility profile of other Candida species was essentially stable.Conclusions The data confirm the increasing resistance of C.tropicalis to fluconazole.Echinocandins such as caspofungin should be the first choice for prevention and empirical therapy of invasive fungal infection.It is necessary to strengthen antifungal resistance surveillance.