四川地区29家医院临床分离真菌的菌种分布及耐药性监测

Distribution and drug resistance monitoring of clinical fungi isolated from 29 hospitals in Sichuan area

目的了解2022年四川地区临床分离真菌的菌株分布以及其对常用抗真菌药物的耐药率,促进四川地区抗真菌药物的合理选择。方法收集2022年1月1日—2022年12月31日全国真菌病监测网四川省29家医院临床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进行数据统计与分析。结果该研究共收集非重复真菌菌株16969株,其中念珠菌属占86.95%(14755/16969);隐球菌属占0.47%(80/16969);曲霉菌占8.07%(1371/16969);其他酵母占4.49%(763/16969)。在念珠菌属中,白念珠菌(63.36%,9350/14755)、光滑念珠菌(15.09%,2222/14755)及热带念珠菌(6.44%,951/14755);在隐球菌属中,新生隐球菌占97.50%(78/80);在曲霉菌中,烟曲霉占比最多(56.16%,770/1371)。所有念珠菌属对两性霉素B、棘白菌素的耐药率或非野生型占比相对较低,光滑念珠菌和热带念珠菌对唑类药物的耐药率或非野生型占比相对较高。新生隐球菌对两性霉素B的非野生型占比为10.29%,略高于唑类药物和氟胞嘧啶。曲霉菌总体对两性霉素B和唑类药物以及卡泊芬净的非野生型占比相对较低。结论四川省2022年临床分离的真菌以念珠菌属为主,光滑念珠菌和热带念珠菌对唑类药物耐药率或非野生型占比相对较高,需进行动态监测。

Objective The distribution of clinically isolated fungi strains and their resistance rate to commonly used antifungal drugs in Sichuan in 2022 was studied to promote the rational selection of antifungal drugs in Sichuan.Methods From January 1,2022 to December 31,2022,non-duplicative fungal strains isolated from 29 hospitals in Sichuan Province of the National Mycosis Surveillance Network were collected and analyzed using WHONET 5.6 and Microsoft Excel according to the recommended standards of the American Clinical and Laboratory Standards Institute(CLSI).Results A total of 16,969 non-repeating fungal strains were collected in this study,among which Candida accounted for 86.95%(14,755/16,969),Cryptococcus accounted for 0.47%(80/16969),Aspergillus accounted for 8.07%(1371/16,969),other yeast accounted for 4.49%(763/16,969).Among the Candida genera are Candida albicans(63.36%,9,350/14,755),Candida glabra(15.09%,2,222/14,755)and Candida tropicalis(6.44%,951/14,755).In Cryptococcus,Cryptococcus neoformans accounted for 97.50%(78/80).Among Aspergillus,Aspergillus fumigatus accounted for the largest proportion(56.16%,770/1,371).The resistance rate or proportion of non-wild type to amphotericin B and echinocinomycin was relatively low in all Candida genera,while the resistance rate or proportion of non-wild type to azole drugs was relatively high in Candida glabrata and Candida tropicalis.The proportion of the non-wild type of Cryptococcus neoformenosa to amphotericin B was 10.29%,which was slightly higher than that of azole drugs and fluorocytosine.The proportion of non-wild type to amphotericin B,azole and carpofungin in Aspergillus was relatively low.Conclusion Candida was the main fungus isolated in Sichuan Province in 2022.Candida glabrata and Candida tropicalis had relatively high resistance rates to azole drugs or a high proportion of non-wild types,which required dynamic monitoring.