四川省19家三级甲等综合医院真菌血流感染病原菌分布及药敏分析

Distribution and drug susceptibility analysis of pathogenic bacteria for fungal bloodstream infection in 19 tertiary first-class general hospitals in Sichuan

目的了解四川省真菌血流感染常见病原菌分布及耐药性,为临床医生经验性治疗真菌血流感染提供参考依据。方法收集2019年11月1日—2020年12月31日四川省19家三级甲等综合医院诊断血流感染的患者在血液培养中分离的真菌菌株,进行质谱鉴定和药敏,对结果进行统计分析,同时对临床资料进行回顾性分析。结果共收到真菌菌株255株,经质谱鉴定,念珠菌属215株(84.3%),新型隐球菌28株(11.0%),马尔尼菲蓝篮状菌4株(1.6%),其他8株(3.1%)。念珠菌属中白念珠菌90株,近平滑念珠菌复合群39株,光滑念珠菌36株,热带念珠菌33株,季也蒙念珠菌8株,其他念珠菌9株。在科室中,以ICU为主,占35.7%。对排名前4的念珠菌(白念珠菌、近平滑念珠菌复合群、光滑念珠菌、热带念珠菌)进行药敏分析,白念珠菌、近平滑念珠菌复合群对抗真菌药物较敏感,白念珠菌对氟康唑的敏感率为89.2%,伏立康唑敏感率为92.8%,阿尼芬净和卡泊芬净的敏感率为97.6%,米卡芬净敏感率96.4%,近平滑念珠菌对氟康唑的敏感率89.7%,对伏立康唑的敏感率94.9%,对阿尼芬净、卡泊芬净、米卡芬净的敏感率为100%。棘白菌素类对念珠菌属的抗菌活性较强,近平滑念珠菌复合群和热带念珠菌对棘白菌素的敏感率为100%,白念珠菌对棘白菌素的敏感率均在95%以上,光滑念珠菌对棘白菌素的敏感率为90%左右。热带念珠菌对氟康唑和伏立康唑的敏感率较低,为66.7%和54.5%,光滑念珠菌对氟康唑的敏感性主要集中在剂量依赖性敏感(SDD),占91.4%。4种念珠菌对两性霉素B均表现为野生型菌株,热带念珠菌对泊沙康唑和伊曲康唑的非野生型率占比最高,为21.2%和36.4%,新型隐球菌的药敏结果显示,23株中4株对两性霉素B表现为非野生型,3株对氟康唑表现为非野生型。结论血流感染的真菌主要是念珠菌属,白念珠菌占比最高,棘白菌素对念珠菌的抗菌效果很好,念珠菌对两性霉素B均表现为野生型,但热带念珠菌对氟康唑和伏立康唑的耐药率稍高,新型隐球菌对两性霉素B的非野生型率在增加,临床医生应高度重视,合理使用抗真菌药物。

Objective To understand the distribution and drug resistance of common pathogens of fungal bloodstream infection in Sichuan,and to provide reference for clinicians to empirically treat fungal bloodstream infection.MethodsFrom November 1,2019 to December 31,2020,fungal strains isolated from blood culture of patients diagnosed with bloodstream infection in 19 tertiary first-class general hospitals in Sichuan Province were collected for mass spectrometry identification and drug susceptibility,and the results were statistically analyzed,along with a retrospective analysis of clinical data.ResultsA total of 255 fungal strains were received and identified by mass spectrometry,215 strains of Candida spp(84.3%),28 strains of Cryptococcus neoformans(11.0%),4 strains of Talaromyces marneffei(1.6%)and 8 strains of others(3.1%).Among the Candida spp 90 strains of Candida albicans,39 strains of Candida parapsilosis complex,36 strains of Candida glabrata,33 strains of Candida tropicalis,8 strains of Candida guilliermondii,and 9 strains of other Candida.In the department,the ICU was predominant,accounting for 35.7%.The top four Candida(Candida albicans,Candida parapsilosis complex,Candida glabrata,Candida tropicalis)were analyzed for drug sensitivity,Candida albicans and Candida parapsilosis complex group were more sensitive to antifungal drugs,the sensitivity rates of Candida albicans to fluconazole,voriconazole,anidulafungin,caspofungin,micarafungin were 89.2%,92.8%,97.6%,97.6%,96.4%,respectively.The sensitivity rates of Candida parapsilosis to fluconazole and voriconazole were 89.7%and 94.9%,and to anidulafungin,caspofungin and micafungin were all 100%.Echinocandins had stronger antibacterial activity against Candida spp.,Candida parapsilosis complex and Candida tropicalis had 100%sensitivity to echinocandins,Candida albicans had more than 95%sensitivity to echinocandins,and Candida glabrata had about 90%sensitivity to echinocandins.Candida tropicalis was less sensitive to fluconazole and voriconazole with66.7%and 54.5%,and the sensitivity of Candida glabrata to fluconazole was mainly concentrated in susceptible dose dependent(SDD),accounting for 91.4%.The four Candida species did not show resistance to amphotericin B,all of them showed wild-type strains,Candida tropicalis showed the highest non-wild-type rate to posaconazole and itraconazole with21.2%and 36.4%,and the drug sensitivity results of Cryptococcus neoformans showed that 4 out of 23 strains showed resistance to amphotericin B(non-wild-type)and 3 strains showed resistance to fluconazole(non-wild-type).ConclusionsThe fungus of bloodstream infection is mainly Candida spp..Among of them,Candida albicans accounts for the highest percentage,echinocandins have good antibacterial effect on Candida,Candida is sensitive to amphotericin B as wild type,but Candida tropicalis has slightly higher resistance rate to fluconazole and voriconazole,and the non-wild type rate of Cryptococcus neoformans to amphotericin B is increasing,and clinicians should pay high attention to the rational use of antifungal drugs.