2019-2021年四川地区无菌体液念珠菌的分布特征与耐药性变迁

Distribution characteristics and drug resistance changes of Candida in sterile body fluids in Sichuan from 2019 to 2021

目的回顾性分析2019—2021年全国真菌病监测网四川省监测中心30家成员单位无菌体液念珠菌的分布特征及对唑类抗真菌药物的耐药情况,为临床医生经验性治疗无菌体液念珠菌感染提供参考依据。方法收集2019-2021年全国真菌病监测网四川省监测中心30家成员单位无菌体液念珠菌的鉴定和药物敏感性试验数据,对其进行统计分析。结果30家成员单位无菌体液共分离出念珠菌1933株,其中白念珠菌921株,光滑念珠菌313株,近平滑念珠菌300株,热带念珠菌259株,其他念珠菌140株。1933株念珠菌标本类型为血液1059株、腹水527株、胆汁155株、胸腔积液117株、脑脊液33株、胃液23株、关节液17株、骨髓2株,来源于8种无菌体液标本。1613株有完整药物敏感性试验结果(来自血液标本920株,来自其余7种无菌体液标本693株)。所有无菌体液中的白念珠菌对氟康唑和伏立康唑的敏感率较高,均保持在80%以上;近平滑念珠菌对氟康唑和伏立康唑的耐药率不高,但呈上升趋势;热带念珠菌对氟康唑和伏立康唑耐药率逐年升高;分离的光滑念珠菌对氟康唑和伏立康唑的耐药率均较高。结论无菌体液分离的念珠菌主要来自血液,氟康唑和伏立康唑对白念珠菌的抗菌效果较好,但其他非白念珠菌对氟康唑和伏立康唑的耐药率较高,分离自血液的念珠菌比分离自其余7种无菌体液的念珠菌耐药性更高一些,临床医生应高度重视,合理使用抗真菌药物。

Objective To retrospectively analyze the detection of Candida in sterile body fluids and drug resistance to azole antifungal agents in 30 member units of National Mycosis Surveillance Network Sichuan Monitoring Center from 2019 to 2021,and to provide reference for clinicians in the empirical treatment of Candida infection in sterile body fluid.Methods The data of identification and drug susceptibility of Candida in aseptic body fluid from 30 member units of National Mycosis Surveillance Network Sichuan Monitoring Center from 2019 to 2021 were collected and analyzed statistically.Results A total of 1933 strains of Candida were isolated from sterile body fluids of 30 member units,including 921 strains of Candida albicans,313 strains of Candida glabratas,300 strains of Candida parapsiolosis,259 strains of Candida tropialis and 140 strains of other Candida.The 1933 strains of Candida were derived from 8 kinds of sterile body fluids,including 1059 strains of blood,527 strains of ascites,155 strains of bile,117 strains of pleural effusion,33 strains of cerebrospinal fluid,23 strains of gastric fluid,17 strains of articular fluid and 2 strains of bone marrow.Complete drug susceptibility test results were obtained for 1613 strains(920 strains from blood samples and 693 strains from the remaining 7 sterile body fluids).The sensitivity rate of Candida albicans in all sterile body fluids to fluconazole and voriconazole was high,which remained above 80%.The drug resistance rate of Candida parapsiolosis to fluconazole and voriconazole was not high,but showed an upward trend.The resistance rate of Candida tropicalis to fluconazole and voriconazole increased year by year.The resistance rate of Candida glabratas isolated to fluconazole was 14.8%.Conclusion Candida isolated from sterile body fluids mainly come from blood.Fluconazole and voriconazole have good antibacterial effect on Candida albicans,but other non-Candida albicans have a high resistance rate to fluconazole and voriconazole.Candida isolated from blood has a higher resistance than Candida isolated from the other seven kinds of sterile body fluid.Clinicians should attach great importance to the rational use of antifungal drugs.