海南省2013—2022年某真菌监测网点分离念珠菌的耐药性及血清学检测

Drug resistance and serological detection of Candida isolated from a fungal surveillance network in Hainan province from 2013 to 2022

目的收集2013—2022年海南省某真菌监测网点分离真菌的数据,分析念珠菌的耐药特点及血清学检测的结果,为临床诊断和治疗提供依据。方法按照全国真菌耐药监测网技术方案,用SQL语言从微生物鉴定系统数据库中提取2013—2022年海南省符合要求的真菌数据,并对数据信息进行分析,统计学使用SPSS 26.0软件。结果在2013—2022年分离真菌5503株的临床标本来源中,宫颈口分泌物占30.37%(1671株)、中段尿占23.55%(1296株)、下呼吸道标本占25.24%(1389株)[痰液占20.37%(1121株)、肺泡灌洗液占4.87%(268株)]、伤口脓液占9.59%(528株)、腹水占5.60%(308株)、血液占3.67%(202株),脑脊液占0.38%(21株)、关节液占0.04%(2株),2022年分离菌株最多,2013年分离菌株最少,2022年是2013年的约2.6倍。3312株白念珠菌在类酵母型真菌中占比最高为60.2%,白念珠菌对氟康唑的耐药率最高为16.7%,对两性霉素B的“非野生型”(non-wild-type,NWT)为2.5%;热带念珠菌对氟康唑的耐药率最高为36.0%,对氟康唑的NWT为41.1%,对两性霉素B的NWT为3.1%;光滑念珠菌对氟康唑的耐药率为2.8%、剂量依赖性敏感(dose dependent sensitivity,SDD)为97.2%、NWT为15.5%,对伊曲康唑的NWT为8.6%;近平滑念珠菌对氟康唑的耐药率最高为15.7%,对两性霉素B的NWT为8.3%;克柔念珠菌对卡泊芬净的耐药率为0.0%;都柏林念珠菌对氟康唑的NWT为100.0%。在70例血培养阳性的标本中,G试验检测64例和Mn检测25例,血培养阳性分别与G检测和Mn检测比较,差异均具有统计学意义(P<0.01)。结论真菌血清学试验可弥补血培养的不足并且能鉴别真菌的侵袭和定植,结合2种方法的优势,为临床有效控制真菌感染提供依据。

Objective To collect data of fungi isolated from a fungus monitoring network in Hainan Province from 2013 to 2022,and analyze the drug resistance characteristics of Candida and the results of serological tests,with an aim to provide a basis for clinical diagnosis and treatment.Methods In accordance with the National Fungal Drug Resistance Monitoring Network technical scheme,the qualifying fungal data were extracted from the microbial identification system database using SQL language,and the data information was then analyzed,with statistical processing done using SPSS 26.0 software.Results Among 5503 fungal isolates from clinical specimens between 2013 and 2022,cervical orifice secretions accounted for 30.37%(1671 strains),mid-stream urine for 23.55%(1296 strains),lower respiratory tract specimens for 25.24%(1389 strains)[(sputum for 20.37%(1121 strains)and alveolar lavage fluid for 4.87%(268 strains)],wound pus for 9.59%(528 strains),ascites for 5.60%(308 strains),blood for 3.67%(202 strains),cerebrospinal fluid for 0.38%(21 strains),and joint fluid for 0.04%(2 strains),with the highest number of strains isolated in 2022 and the lowest in 2013,the 2022 figure is about 2.6 times that of 2013.Among yeast-like fungi,Candida albicans had the highest proportion with 3312 strains accounting for 60.2%;The highest resistance rate of Candida albicans was to fluconazole at 16.7%,with 2.5%being non-wild type(NWT)for amphotericin B;Candida tropicalis had the highest rate of resistance to fluconazole at 36.0%,with NWT at 41.1%for fluconazole and 3.1%for amphotericin B;Candida glabrata had a resistance rate to fluconazole of 2.8%,dose-dependent susceptibility(SDD)of 97.2%,NWT of 15.5%for fluconazole,and NWT of 8.6%for itraconazole;Candida parapsilosis had the highest resistance rate to fluconazole at 15.7%and and NWT of 8.3%for amphotericin B;Candida krusei had a 0.0%resistance rate to caspofungin;and Candida dubliniensis was 100.0%NWT to fluconazole.Of 70 cases of blood culture-positive specimens,64 cases were detected by G test and 25 cases by Mn test,and the positive blood cultures were statistically significant when compared with the G test and Mn test,respectively(P<0.01).Conclusions Fungal serological test can make up for the deficiency of blood culture and distinguish fungal invasion and colonization,thus providing a basis for the effective control of fungal infection in clinical practice.