Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities
Nosocomial bloodstream infections due to Candida spp. in the USA: species distribution, clinical features and antifungal susceptibilities
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DOI：
10.1016/j.ijantimicag.2013.09.005
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发表时间：
2014-01-01
影响因子：
10.8
通讯作者：
Seifert, Harald
中科院分区：
文献类型：
--
作者：
Wisplinghoff, Hilmar;Ebbers, Jenny;Seifert, Harald
念珠菌属是最常见的医院病原体之一，对发病率和死亡率有重大影响。关于念珠菌血流感染（BSI）流行病学的纵向数据仍然有限。前瞻性地收集了 1998 年至 2006 年间美国 52 家医院患者 1218 例念珠菌 BSI 发作的分离株和临床数据。根据 CLSI 参考文献确定了 1077 株念珠菌分离株对两性霉素 B、氟胞嘧啶、氟康唑、泊沙康唑、伏立康唑、阿尼芬净、卡泊芬净和米卡芬净的敏感性肉汤微量稀释法使用最近发表的物种特异性临床断点。白色念珠菌是最常见的物种（50.7%），其次是近平滑念珠菌（17.4%）、光滑念珠菌（16.7%）和热带念珠菌（10.2%）。非白色念珠菌属的流行。随着时间的推移而增加。患者的平均年龄为 51 岁，BSI 之前的平均住院时间为 22 天。主要基础疾病为胃肠道疾病（20.1%）和肺部疾病（13.0%）。静脉导管（19.1%）和尿路（8.0%）是最常确定的可能来源，而大多数患者（61.1%）无法确定来源。总死亡率为38.1%。在研究的分离株中，0.8% 的白色念珠菌、100.0% 的光滑念珠菌、2.9% 的近平滑念珠菌和 4.9% 的热带念珠菌对氟康唑不敏感，0.6% 的白色念珠菌、5.0% 的克柔念珠菌、7.6% 的近平滑念珠菌和 9.8% 的念珠菌对氟康唑不敏感。热带假丝酵母对伏立康唑不敏感。所有棘白菌素对大多数念珠菌属（包括大多数近平滑念珠菌分离株）均表现出良好的活性，但只有 38.1% 的光滑念珠菌经测试对卡泊芬净敏感。 (C) 2013 Elsevier B. V. 和国际化疗协会。版权所有。
Candida spp. are among the most frequent nosocomial pathogens, contributing significantly to morbidity and mortality. Longitudinal data on the epidemiology of Candida bloodstream infections (BSIs) are still limited. Isolates and clinical data from 1218 episodes of Candida BSI were prospectively collected from patients in 52 hospitals in the USA between 1998 and 2006. Susceptibilities to amphotericin B, flucytosine, fluconazole, posaconazole, voriconazole, anidulafungin, caspofungin and micafungin were determined for 1077 Candida isolates by the CLSI reference broth microdilution method using the recently published species-specific clinical breakpoints. Candida albicans was the most prevalent species (50.7%), followed by Candida parapsilosis (17.4%), Candida glabrata (16.7%) and Candida tropicalis (10.2%). The prevalence of non-albicans Candida spp. increased over time. Patients had a mean age of 51 years and a mean length of hospital stay prior to BSI of 22 days. The main underlying conditions were gastrointestinal (20.1%) and pulmonary (13.0%) diseases. Intravenous catheters (19.1%) and the urinary tract (8.0%) were the most frequently determined likely sources, whilst in the majority of patients (61.1%) no source could be identified. Overall mortality was 38.1%. Of the isolates studied, 0.8% of C. albicans, 100.0% of C. glabrata, 2.9% of C. parapsilosis and 4.9% of C. tropicalis were non-susceptible to fluconazole, and 0.6% of C. albicans, 5.0% of Candida krusei, 7.6% of C. parapsilosis and 9.8% of C. tropicalis were non-susceptible to voriconazole. All echinocandins showed good activity against most Candida spp., including the majority of C. parapsilosis isolates, but only 38.1% of C. glabrata tested susceptible to caspofungin. (C) 2013 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved.