2021年四川省临床分离真菌的菌种分布及耐药性监测

Species distribution and surveillance of drug resistance of clinical fungalisolates in Sichuan province in 2021

目的了解2021年全国真菌病监测网四川省监测中心30家成员单位临床微生物标本分离真菌的菌株分布及其对常见抗真菌药物的体外敏感性,为区域真菌流行病学数据提供资料。方法收集2021年全国真菌病监测网四川省监测中心30家成员单位临床微生物标本中分离的非重复真菌菌株,参照美国临床和实验室标准协会(CLSI)推荐标准,运用WHONET 5.6及Microsoft Excel进行数据统计分析。结果该研究收集真菌菌株标本共计29038株,其中念珠菌属占85.28%(24765/29038);隐球菌属占0.56%(163/29038);丝状真菌占11.41%(3312/29038);其他酵母占2.75%(798/29038)。在念珠菌属中,计数最多的3种念珠菌分别为白念珠菌(59.98%,14853/24765)、光滑念珠菌(14.81%,3668/24765)及热带念珠菌(9.32%,2308/24765);在隐球菌属中,新生隐球菌占96.93%(158/163);在丝状真菌中,烟曲霉占比最多,为37.80%(1252/3312)。所有念珠菌属对两性霉素B的耐药率均较低,耐药率均低于2%,白念珠菌对棘白菌素类药物的耐药率较低,光滑念珠菌对伏立康唑和泊沙康唑的耐药率较高,热带念珠菌对所有康唑类药物的耐药率均较高,而对棘白菌素类药物耐药率较低。新生隐球菌对两性霉素B的耐药率为12.8%,略高于唑类抗真菌药物。丝状真菌中,烟曲霉对两性霉素B的耐药率较高(39.1%),对卡泊芬净、伊曲康唑和伏立康唑的耐药率较低。结论该研究临床分离的真菌以念珠菌属为主,念珠菌属对两性霉素B耐药率均较低,光滑念珠菌和热带念珠菌对唑类抗真菌药物的耐药率较高,应引起临床医师的重视。

Objective To investigate the distribution of fungal strains isolated from clinical microbial specimens and their in vitro susceptibility to common antifungal drugs in 30 member units of National Mycosis Surveillance Network Sichuan Monitoring Center in 2021,and to provide information for regional fungal epidemiological data.Methods Nonrepeating fungal strains isolated from clinical specimens of 30 member units of National Mycosis Surveillance Network Sichuan Monitoring Center in 2021 were collected and statistically analyzed by WHONET 5.6 and Microsoft Excel according to the recommended standards of American Institute of Clinical and Laboratory Standards(CLSI).Results A total number of 29038 clinical fungal isolates were collected in this study,among which 85.28%(24765/29038)were Candida species,0.56%(163/29038)were Cryptococcus species,11.41%(3312/29038)were filamentous fungus,and 2.75%(798/29038)were other yeast.In the Candida species,the top three clinical isolates were Candida albicans(59.98%,14853/24765),Candida glabrata(14.81%,3668/24765),and Candida tropicalis(9.32%,2308/24765).The percentage of Cryptococcus neoformans in the Cryptococcus species was 96.93%(158/163),and the most common filamentous fungus isolate was Aspergillus fumigatus(37.80%,1252/3312).The drug resistance of all the Candida species was low to amphotericin B,with the resistance rate less than 2%.The resistance of Candida albicans to echinocandins was low,and the resistance of Candida glabrata to voriconazole and Posaconazole was high.The drug resistance of Candida tropicalis was high to all the triazoles,while was relatively lower to echinocandins.The resistance of Cryptococcus neoformans to amphotericin B was 12.8%,relatively higher than to the triazoles antifungal drug.Among the filamentous fungus,the resistance of Aspergillus fumigatus was high(39.1%)to amphotericin B,and was low to caspofungin,itraconazole and voriconazole.Conclusion The clinical fungal isolates in this study is mainly Candida species.The resistance rate of Candida species to amphotericin B is low,while Candida glabrata and Candida tropicalis show high drug resistance to triazoles antifungal drug,which should be take into consideration while treating fungal infections.