背景:口腔念珠菌病(OC)是人类免疫缺陷病毒(HIV)感染患者中普遍存在的机会性感染。患有OC的HIV阳性个体对抗真菌剂的耐药性增加引起了人们的关注。因此,本研究旨在调查HIV阳性患者中耐药OC的患病率.
方法:发布,WebofScience,Scopus,截至2023年11月30日,系统搜索了Embase数据库中符合条件的文章。包括报告从HIV阳性OC患者中分离出的念珠菌对抗真菌药具有抗性的研究。基线特征,临床特征,分离的念珠菌,抗真菌耐药性由两名评审员独立提取。使用随机效应模型或固定效应模型计算具有95%置信区间(CI)的合并患病率。
结果:在1942年的记录中,由2564种念珠菌组成的25项研究进入了荟萃分析。对抗真菌药的耐药性汇总如下:酮康唑(25.5%,95%CI:15.1-35.8%),氟康唑(24.8%,95%CI:17.4-32.1%),5-氟胞嘧啶(22.9%,95%CI:-13.7-59.6%),伊曲康唑(20.0%,95%CI:10.0-26.0%),伏立康唑(20.0%,95%CI:1.9-38.0%),咪康唑(15.0%,95%CI:5.1-26.0%),克霉唑(13.4%,95%CI:2.3-24.5%),制霉菌素(4.9%,95%CI:-0.05-10.3%),两性霉素B(2.9%,95%CI:0.5-5.3%),和卡泊芬净(0.1%,95%CI:-0.3-0.6%)。此外,几乎所有纳入的关于不同抗真菌药物耐药性的研究都存在高度异质性(I2>50.00%,P<0.01),卡泊芬净除外(I2=0.00%,P=0.65)。
结论:我们的研究表明,在患有OC的HIV阳性患者中发现的大量念珠菌对唑类药物和5-氟胞嘧啶具有抗性。然而,大多数分离株对制霉菌素敏感,两性霉素B,还有Caspofungin.这表明OC的初始治疗,如唑类,可能没有效果。在这种情况下,医疗保健提供者可能需要考虑处方替代疗法,如多烯和卡泊芬净。
背景:该研究方案已在国际前瞻性系统评价登记册中注册为PROSPERO(编号:CRD42024497963)。
BACKGROUND: Oral candidiasis (OC) is a prevalent opportunistic infection in patients with human immunodeficiency virus (HIV) infection. The increasing resistance to antifungal agents in HIV-positive individuals suffering from OC raised concerns. Thus, this study aimed to investigate the prevalence of drug-resistant OC in HIV-positive patients.
METHODS: Pubmed, Web of Science, Scopus, and Embase databases were systematically searched for eligible articles up to November 30, 2023. Studies reporting resistance to antifungal agents in Candida species isolated from HIV-positive patients with OC were included. Baseline characteristics, clinical features, isolated Candida species, and antifungal resistance were independently extracted by two reviewers. The pooled prevalence with a 95% confidence interval (CI) was calculated using the random effect model or fixed effect model.
RESULTS: Out of the 1942 records, 25 studies consisting of 2564 Candida species entered the meta-analysis. The pooled prevalence of resistance to the antifungal agents was as follows: ketoconazole (25.5%, 95% CI: 15.1-35.8%), fluconazole (24.8%, 95% CI: 17.4-32.1%), 5-Flucytosine (22.9%, 95% CI: -13.7-59.6%), itraconazole (20.0%, 95% CI: 10.0-26.0%), voriconazole (20.0%, 95% CI: 1.9-38.0%), miconazole (15.0%, 95% CI: 5.1-26.0%), clotrimazole (13.4%, 95% CI: 2.3-24.5%), nystatin (4.9%, 95% CI: -0.05-10.3%), amphotericin B (2.9%, 95% CI: 0.5-5.3%), and caspofungin (0.1%, 95% CI: -0.3-0.6%). Furthermore, there were high heterogeneities among almost all included studies regarding the resistance to different antifungal agents (I2 > 50.00%, P < 0.01), except for caspofungin (I2 = 0.00%, P = 0.65).
CONCLUSIONS: Our research revealed that a significant number of Candida species found in HIV-positive patients with OC were resistant to azoles and 5-fluocytosine. However, most of the isolates were susceptible to nystatin, amphotericin B, and caspofungin. This suggests that initial treatments for OC, such as azoles, may not be effective. In such cases, healthcare providers may need to consider prescribing alternative treatments like polyenes and caspofungin.
BACKGROUND: The study protocol was registered in the International Prospective Register of Systematic Reviews as PROSPERO (Number: CRD42024497963).