2019年—2021年某地区临床分离的侵袭性真菌流行病学及耐药性分析

Epidemiological and drug resistance analysis of clinically isolated invasive Fungi in an area from 2019 to 2021

目的 了解平湖地区3家医院感染侵袭性真菌的菌种分布及对常用抗真菌药物的敏感性和耐药性。方法 收集本地区2019年1月—2021年12月临床分离的侵袭性酵母样真菌,对所有菌株均采用质谱鉴定,统一采用比色微量肉汤稀释法进行抗真菌药物敏感性试验。结果 临床分离念珠菌共94株,其中白念珠菌占37.23%(35/94)。2019年—2021年白念珠菌的分离率均排在第一位,分离率分别为31.03%、31.25%、48.48%,呈逐年上升趋势(χ^(2)_(趋势)=6.663,P=0.016)。老年患者热带念珠菌对氟康唑和伏立康唑的耐药率均为60.00%,非老年患者均为33.33%。检出的14株热带念珠菌中,6株热带念珠菌对唑类药物耐药,并对氟康唑和伏立康唑呈现交叉耐药;未发现4种常见致病念珠菌对棘白菌素和两性霉素B耐药菌株。结论 本地区临床白念珠菌的分离率逐年升高,流行具有一定的地域性特征;热带念珠菌对唑类抗真菌药物的耐药率较高,并且有上升趋势,值得临床在治疗过程中关注。

Objective This paper aims to investigate the distribution of invasive Fungi and their susceptibility and resistance to antifungal drugs in three hospitals in Pinghu area. Methods Invasive yeast-like Fungi clinically isolated from the region from January 2019 to December 2021 were collected, and all strains were identified by mass spectrometry. Colorimetric microbroth dilution method was used to carry out anti-fungal susceptibility tests. Results A total of 94 Candida isolates were collected, of which Candida albicans accounted for 37.23%(35/94). From 2019 to 2021, the isolation rate of Candida albicans ranked the first, and the isolation rates were 31.03%, 31.25% and 48.48%, respectively, showing an increasing trend year by year(χ^(2)_(trend)=6.663, P=0.016). The resistance rates of Candida tropicalis to fluconazole and voriconazole were 60.00% in elderly patients and 33.33% in non-elderly patients. Among 14 strains of Candida tropicalis detected, 6 strains of Candida tropicalis were resistant to azole and showed cross-resistance to fluconazole and voriconazole. The four common pathogenic candida strains were not found resistant to echinocin and amphotericin B. Conclusion The isolation rate of clinical Candida albicans increased year by year in this region, and the prevalence had certain regional characteristics. The resistance rate of Candida tropicalis to azole antifungal drugs is high and has an increasing trend, which is worthy of clinical attention in the course of treatment.