2012年度侵袭性真菌耐药监测网(CHIF-NET)侵袭性酵母菌感染的分布特征

Distribution characteristics of invasive yeast infections in China Hospital Invasive Fungal Surveillance Net(CHIF-NET)in 2012

目的目前我国侵袭性酵母菌发病率呈明显上升趋势,本研究旨在分析中国医院侵袭性真菌监测网(China Hospital Invasive Fungal Surveillance Net,CHIF-NET)2012年流行病学数据。方法研究数据来自中国的22家三级医院,共收集到1619株念珠菌。研究采用基质辅助激光解析电离飞行时间质谱,结合ITS测序技术进行菌种鉴定,用美国临床和实验室标准协会(CLSI)推荐的纸片扩散法(kirby-Bauer,K-B)测定氟康唑和伏立康唑药物敏感性。结果本研究标本类型中来自于外周血液标本的菌株626株,占38.67%,来自其他部位(包括腹水、脓肿、静脉导管、脑脊液、肺泡灌洗液、胆汁、胸水、组织、关节积液和胃液)标本993株,占61.33%,其中分离自腹水的菌株354株占21.87%,分离自脓肿的菌株159株占9.82%,分离自其余标本类型的菌株数量较少(<8%)。1619株念珠菌分离自除血液以外其他部位的菌种,以白念珠菌为主(491株占49.45%),其次为热带念珠菌(164株占16.52%),其余种数量较少(<11%)。检出侵袭性酵母菌患者中男性1006株占62.1%,女性612株占37.8%,年龄范围0~94岁,其中≥65岁患者498株占30.76%。在侵袭性念珠菌感染中,绝大部分白念珠菌对氟康唑和伏立康唑敏感[耐药率(R)<1%],其次为近平滑念珠菌(R<6%)及热带念珠菌(R<7%)。另外,不同念珠菌在不同的医疗机构有分布差异。结论中国侵袭性酵母菌感染的分布与多种因素有关,包括感染部位、地域、年龄等,故仍需持续监测。

Objective Incidence rate of invasive yeasts increased significantly in China.This study reported the datas of the China Hospital Invasive Fungal Surveillance Net(CHIF-NET)in 2012.Methods A total of 1619 Candida strains were collected from 22 hospitals in China.The sensitivity of fluconazole and voriconazole were determined by matrix-assisted laser desorption/ionization time of flight mass spectrometry and ITS sequencing.The drug sensitivities of fluconazole and voriconazole were determined by kirby Bauer,K-B,recommended by the American institute of clinical laboratory standardization(CLSI).Results In this study,626 strains from blood samples accounted for 38.67%.There were 993 strains from other parts(including ascitic fluid,pus,venous catheter,cerebrospinal fluid,bronchoalveolar lavage fluid,bile,pleural fluid,tissue,hydrarthrosis and gastric juice),accounting for 61.33%.Among them,354 strains isolated from ascites accounted for 21.8%,159 strains isolated from pus accounted for 9.8%,and fewer strains isolated from other sample types(<8%).Among 1619 strains of Candida isolated Other parts except blood,491 strains were mainly Candida albicans,accounting for 49.45%,followed by 164 strains of Candida tropicalis,accounting for 16.52%,and the number of other species was small(<10%).Among the patients with invasive yeast detected,there were 1,006 male patients accounting for 62.1%and 612 female patients accounting for 37.8%.The age range was 0-94 years old,among which 498 patients≥65 years accounted for 30.76%.In invasive candida infection,most Candida albicans were sensitive to fluconazole and voriconazole(R<1%),followed by Candida parapsilosis(R<6%)and Candida tropicalis(R<7%).In addition,different Candida species have different geographical distribution.Conclusion Studies howed that the distribution of invasive yeast infection in China was related to many factors including infection site,region and age.Therefore,continuous monitoring is needed.