全国多中心血流分离近平滑念珠菌药物敏感性和分子流行病学回顾性研究

Multicenter retrospective study on antifungal susceptibility and molecular epidemiology of Candida parapsilosis isolated from bloodstream infections in China

目的对全国多中心收集的血流感染近平滑念珠菌进行分子流行病学和药物敏感性分析。方法将全国42家医院377例血流感染患者中分离的非重复菌株纳入研究,采用美国临床和实验室标准协会(CLSI)M44-A2纸片扩散法进行氟康唑和伏立康唑敏感性检测,采用微卫星分型方法对所有菌株进行分子流行病学分析。结果377例患者中,46.2%的患者年龄超过60岁;分别有26.5%、23.9%、21.8%和12.5%的患者分布于外科病房、内科病房、综合ICU和外科ICU病房。377株近平滑念珠菌中,24株(6.4%)对氟康唑耐药,10株(2.7%)对伏立康唑耐药。微卫星分型结果显示,所有菌株共分为172个微卫星型别(microsatellite genotype,MT),125个MT型别各自仅在单个菌株中出现;28家医院内经分析存在65例同家医院内不同患者感染同型别菌株的情况,其中同型别氟康唑耐药株在同家医院内感染不同患者的情况为6例。结论本研究回顾分析全国多中心血流感染近平滑念珠菌的分子流行病学,在多家医院内均发现同型别菌株包括氟康唑耐药菌株分离于不同患者的情况,提示存在近平滑念珠菌院内传播的可能。

Objectives The present study was to conduct molecular epidemiology and antifungal susceptibilities of C.parapsilosis retrospectively based on multicenter isolates nationwide in China.Methods Atotal of 377 non-duplicated C.parapsilosis isolates from bloodstream infections were collected from unique patients from 42 hospitals across China.Antifungal susceptibility touconazole and voriconazole was determined for all isolates using the CLSI M44-A2 disc diffusion method.C.parapsilosis isolates were genotyped using four highly polymorphic microsatellite markers.Results Of the 377 patients,46.2%were over 60 years old.26.5%,23.9%,21.8%and 12.5%patients were located in surgical ward,medicine ward,general ICU and surgical ICU respectively.Among 377 strains,24(6.4%)were resistant to fluconazole and 10(2.7%)to voriconazole.Microsatellite typing showed that all strains were divided into 172 microsatellite types,125 MT types only appeared in a single strain;in 28 hospitals,there were 65 cases of which different patients in the same hospital were infected with the same MT type of strains,among which 6 cases indicated different patients were infected with the same MT type of fluconazole resistant strains in the same hospital.Conclusions Here we presented the nationwide molecular epidemiology study of C.parapsilosis causing bloodstream infections in China,and identified several cases of which different patients in the same hospital were infected with the same MT type of strains including antifungal resistant isolates,indicating probable horizontal transmission of C.parapsilosis in hospitals.