苏州某三甲医院念珠菌菌血症调查及耐药性分析

Investigation and drug resistance analysis of candidemia in a tertiary hospital in Suzhou

目的 分析念珠菌菌血症流行病学特征及耐药情况。方法 收集2015年1月—2019年12月念珠菌菌血症中分离的65株菌,通过显色法和质谱仪鉴定,采用微量肉汤稀释法分别测定棘白菌素、5-氟胞嘧啶、两性霉素、氟康唑、伏立康唑和伊曲康唑MIC值并采用单中心回顾性方法收集患者的临床资料,进行Fisher精确检验和卡方检验。结果 本研究中白念珠菌和光滑念珠菌总体分离率分别为47.7%和26.2%。伊曲康唑的总体耐药率最高为15.9%,热带念珠菌联合耐药率高为50%(P<0.001)。有无静脉置管与念珠菌血症预后有关(P=0.018)。结论 念珠菌菌血症中白念珠菌为常见菌,光滑念珠菌在念珠菌菌血症中比例较高。伊曲康唑对血液念珠菌耐药率高,热带念珠菌易产生唑类联合耐药。临床经验性用药应结合地区念珠菌流行病学特征。

Objective To investigate epidemiological characteristics and drug resistance in candidemia.Methods A total of 65 strains of Candida from candidemia were collected from January 2015 to December 2019.The Candida species were identified by chromogenic plate and MALDI-TOF. The micro broth dilution method was used to determine the MIC values of echinocandin, 5-FC, AMB, FCA, ITR, VRC, and AMB. The single-center retrospective method was used to collect clinical data of patients who were infected by candidemia. Finally, tests were performed using Fisher exact test or the Chi-squared test. Results The most common Candida species during the study period were C. albicans(47.7%) and C. glabrata(26.2%). Itraconazole had the highest resistance rate(15.9%), and C. tropicalis had a high resistance rate of 50% to multi-drugs(P<0.001). Presence of CVC was the only independent predictor of prognosis in candidemia(P=0.018). Conclusion C. albicans had the highest frequency in candidemia. The proportion of C. glabrata in candidemia was increased. The Candida spp. in candidemia had a high rate of resistance to ITR. C. tropicalis was susceptible to azole resistance. Clinical empirical medication should be combined with the epidemiological characteristics of Candida in the region.