PDF(Pubmed)
Abstract：
The prevalence of invasive candidiasis caused by non-Candida albicans has rapidly increased. Candida glabrata (Nakaseomyces glabrata) is an important pathogen associated with substantial mortality. Our study examined the antifungal temporal susceptibility of C. glabrata and cross-resistance/non-wild-type patterns with other azoles and echinocandins. Laboratory data of all adult patients with C. glabrata isolated from clinical specimens at the Mayo Clinic, Rochester, from 2012 to 2022 were collected. Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints were used. We obtained 1046 C. glabrata isolates from 877 patients. Using CLSI and EUCAST breakpoints, 187 (17.9%) isolates and 256 (24.5%) isolates were fluconazole-resistant, respectively. Focusing on C. glabrata bloodstream infections, fluconazole-resistance ranged from 16 to 22%. Among those 187 fluconazole-resistant isolates, 187 (100%) and 184 (98.4%) isolates were also voriconazole and posaconazole non-wild-type, respectively, with 97 (51.9%) isolates deemed non-wild type for itraconazole. The fluconazole susceptibility pattern has not changed over the past decade. The proportion of fluconazole-resistant C. glabrata is relatively high, which could be due to the complexity of patients and fluconazole exposure. Itraconazole appears to be a compelling step-down therapy for fluconazole-resistant C. glabrata, given the high proportion of wild-type isolates. Further research to examine clinical outcomes is warranted.
摘要：
由非白色念珠菌引起的侵袭性念珠菌病的患病率迅速增加。光滑念珠菌（Nakaseomycesglabrata）是与大量死亡率相关的重要病原体。我们的研究检查了光滑梭菌的抗真菌时间敏感性以及与其他唑类药物和棘白菌素的交叉抗性/非野生型模式。从梅奥诊所的临床标本中分离出的所有成年光滑衣原体患者的实验室数据，罗切斯特,从2012年到2022年被收集。使用临床和实验室标准协会(CLSI)和欧洲抗菌药物敏感性测试委员会(EUCAST)断点。我们从877名患者中获得了1046株光滑C.使用CLSI和EUCAST断点，187株（17.9%）和256株（24.5%）对氟康唑耐药，分别。专注于光滑梭菌血流感染，氟康唑耐药率为16％至22％。在187株氟康唑耐药菌株中，187（100％）和184（98.4％）分离株也是伏立康唑和泊沙康唑非野生型，分别,其中97个（51.9%）分离株被认为是伊曲康唑的非野生型。在过去的十年中，氟康唑的敏感性模式没有改变。耐氟康唑的光滑梭菌比例相对较高，这可能是由于患者的复杂性和氟康唑暴露。伊曲康唑似乎是氟康唑耐药光滑梭菌的一种引人注目的降压疗法，鉴于野生型分离株的比例很高。需要进一步的研究来检查临床结果。
