2012年度侵袭性真菌耐药监测网(CHIF-NET)侵袭性酵母菌感染的分布特征

中国真菌学杂志　 2021, Vol. 16 　Issue (4): 234-242.

2012年度侵袭性真菌耐药监测网(CHIF-NET)侵袭性酵母菌感染的分布特征

段思蒙^1,2, 肖盟^1,2, 黄晶晶^1,2, 王贺³, 张戈^1,2, 张京家^1,2, 康巍^1,2, 王瞳^1,2, 肖玉玲⁴, 倪芳⁵, 高岚美⁶, 叶丽艳⁷, 郭鹏豪⁸, 万喆⁹, 陈中举¹⁰, 杨青¹¹, 林洁¹², 胡庆丰¹³, 李虹玲¹⁴, 岳娜¹⁵, 崔兰英¹⁶, 李刚¹⁷, 范会¹⁸, 苏丹虹¹⁹, 刘丽文²⁰, 田素飞²¹, 赵声远²², 杜雪飞²³, 周宏伟²⁴, 徐英春^1,2

1. 中国医学科学院北京协和医学院北京协和医院检验科, 北京 100730;
2. "侵袭性真菌病机制研究与精准诊断"北京市重点实验室, 北京 100730;
3. 丹娜(天津)生物科技有限公司, 天津 300451;
4. 四川大学华西医院, 成都 610041;
5. 江苏省人民医院(南京医科大学第一附属医院), 南京 210029;
6. 福建医科大学附属协和医院, 福州 350001;
7. 解放军总医院, 北京 100036;
8. 中山大学附属第一医院, 广州 510080;
9. 北京大学第一医院, 北京 100034;
10. 华中科技大学同济医学院附属同济医院, 武汉 4300030;
11. 浙江大学医学院附属第一医院, 杭州 310003;
12. 杭州邵逸夫医院, 杭州 310016;
13. 浙江省人民医院, 杭州 310014;
14. 中南大学湘雅医院, 长沙 410008;
15. 天津医科大学总医院, 天津 300052;
16. 哈尔滨医科大学附属第一医院, 哈尔滨 150001;
17. 宁夏医科大学总医院, 银川 750001;
18. 山东省立医院, 济南 250021;
19. 广州医学院第一附属医院, 广州 510120;
20. 辽宁省人民医院, 沈阳 110000;
21. 中国医科大学附属第一医院, 沈阳 110001;
22. 上海交通大学医学院附属瑞金医院, 上海 200025;
23. 哈尔滨医科大学附属第四医院, 哈尔滨 150001;
24. 浙江大学医学院附属第二医院, 杭州 310052

收稿日期:2020-05-09 发布日期:2021-08-31
通讯作者: 徐英春,E-mail:xycpumch@139.com E-mail:xycpumch@139.com
作者简介:段思蒙,女(汉族),学士,初级检验师.E-mail:13848188423@163.com
基金资助:
国家自然科学基金青年项目（81802049）

Distribution characteristics of invasive yeast infections in China Hospital Invasive Fungal Surveillance Net(CHIF-NET) in 2012

DUAN Simeng^1,2, XIAO Meng^1,2, HUANG Jingjing^1,2, WANG He³, ZHANG Ge^1,2, ZHANG Jingjia^1,2, KANG Wei^1,2, WANG Tong^1,2, XIAO Yuling⁴, NI Fang⁵, GAO Lanmei⁶, YE Liyan⁷, GUO Penghao⁸, WAN Zhe⁹, CHEN Zhongju¹⁰, YANG Qing¹¹, LIN Jie¹², HU Qingfeng¹³, LI Hongling¹⁴, YUE Na¹⁵, CUI LanYing¹⁶, LI Gang¹⁷, FAN Hui¹⁸, SU Danhong¹⁹, LIU Liwen²⁰, TIAN Sufei²¹, ZHAO Shengyuan²², DU Xuefei²³, ZHOU Hongwei²⁴, XU Yingchun^1,2

1. Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China;
2. Beijing Key Laboratory for Mechanisms Research and Precision Diagnosisof Invasive Fungal Diseases, Beijing 100730, China;
3. Dana(Tianjin) Biotechnology Co., Ltd, Tianjin 300451, China;
4. West China Hospital of Sichuan University, Chengdu 610041, China;
5. Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China;
6. Fujian Medical University Union Hospital, Fuzhou 350001, China;
7. Medical School of Chinese PLA, Beijing 100036, China;
8. The First Affiliated Hospital, SUN Yat-san University, Guangzhou 510080, China;
9. Peking University First Hospital, Beijing 100034, China;
10. Tongji Hospital, Tongji Medical College of HUST, Wuhan 4300030, China;
11. The First Affiliated Hospital of the Zhejiang University School of Medicine, Hangzhou 310003, China;
12. Sir Run Run Shaw Hospital, Hangzhou 310016, China;
13. Zhejiang Province People's Hospital, Hangzhou 310014, China;
14. Xiangya Hospital, Central South University, Changsha 410008, China;
15. General Hospital of Tianjin Medical University, Tianjin 300052, China;
16. The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China;
17. General Hospital of Ningxia Medical University, Yinchuan 750001, China;
18. Shandong Provincial Hospital, Jinan 250021, China;
19. The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;
20. The People's Hospital of Liaoning Province, Shenyang 110000, China;
21. The First Hospital of China Medical University, Shenyang 110001, China;
22. Ruijin Hospital, Shanghai Jiaotong University of Medicine, Shanghai 200025, China;
23. The Fouth Affiliated Hospital of Harbin Medical University, Harbin 150001, China;
24. The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou 310052, China

Received:2020-05-09 Published:2021-08-31

摘要/Abstract

摘要： 目的目前我国侵袭性酵母菌发病率呈明显上升趋势，本研究旨在分析中国医院侵袭性真菌监测网（China Hospital Invasive Fungal Surveillance Net，CHIF-NET）2012年流行病学数据。方法研究数据来自中国的22家三级医院，共收集到1619株念珠菌。研究采用基质辅助激光解析电离飞行时间质谱，结合ITS测序技术进行菌种鉴定，用美国临床和实验室标准协会（CLSI）推荐的纸片扩散法（kirby-Bauer，K-B）测定氟康唑和伏立康唑药物敏感性。结果本研究标本类型中来自于外周血液标本的菌株626株，占38.67%，来自其他部位（包括腹水、脓肿、静脉导管、脑脊液、肺泡灌洗液、胆汁、胸水、组织、关节积液和胃液）标本993株，占61.33%，其中分离自腹水的菌株354株占21.87%，分离自脓肿的菌株159株占9.82%，分离自其余标本类型的菌株数量较少（<8%）。1619株念珠菌分离自除血液以外其他部位的菌种，以白念珠菌为主（491株占49.45%），其次为热带念珠菌（164株占16.52%），其余种数量较少（<11%）。检出侵袭性酵母菌患者中男性1006株占62.1%，女性612株占37.8%，年龄范围0~94岁，其中≥65岁患者498株占30.76%。在侵袭性念珠菌感染中，绝大部分白念珠菌对氟康唑和伏立康唑敏感，其次为近平滑念珠菌（R<6%）及热带念珠菌（R<7%）。另外，不同念珠菌在不同的医疗机构有分布差异。结论中国侵袭性酵母菌感染的分布与多种因素有关，包括感染部位、地域、年龄等，故仍需持续监测。

关键词: 侵袭性念珠菌病, 分布特征, 氟康唑, 伏立康唑

Abstract: Objective Incidence rate of invasive yeasts increased significantly in China. This study reported the datas of the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) in 2012. Methods A total of 1619 Candida strains were collected from 22 hospitals in China. The sensitivity of fluconazole and voriconazole were determined by matrix-assisted laser desorption/ionization time of flight mass spectrometry and ITS sequencing. The drug sensitivities of fluconazole and voriconazole were determined by kirby Bauer, K-B, recommended by the American institute of clinical laboratory standardization (CLSI). Results In this study, 626 strains from blood samples accounted for 38.67%.There were 993 strains from other parts (including ascitic fluid, pus, venous catheter, cerebrospinal fluid, bronchoalveolar lavage fluid, bile, pleural fluid, tissue, hydrarthrosis and gastric juice), accounting for 61.33%. Among them, 354 strains isolated from ascites accounted for 21.8%, 159 strains isolated from pus accounted for 9.8%, and fewer strains isolated from other sample types (<8%). Among 1619 strains of Candida isolated Other parts except blood, 491 strains were mainly Candida albicans, accounting for 49.45%,followed by 164 strains of Candida tropicalis, accounting for 16.52%, and the number of other species was small (<10%). Among the patients with invasive yeast detected, there were 1,006 male patients accounting for 62.1% and 612 female patients accounting for 37.8%. The age range was 0-94 years old, among which 498 patients ≥ 65 years accounted for 30.76%. In invasive candida infection, most Candida albicans were sensitive to fluconazole and voriconazole (R<1%), followed by Candida parapsilosis (R<6%) and Candida tropicalis (R<7%). In addition, different Candida species have different geographical distribution. Conclusion Studies howed that the distribution of invasive yeast infection in China was related to many factors including infection site, region and age. Therefore, continuous monitoring is needed.

Key words: invasive yeast, distribution characteristics, fluconazole, voriconazole

中图分类号:

R519A

段思蒙, 肖盟, 黄晶晶, 王贺, 张戈, 张京家, 康巍, 王瞳, 肖玉玲, 倪芳, 高岚美, 叶丽艳, 郭鹏豪, 万喆, 陈中举, 杨青, 林洁, 胡庆丰, 李虹玲, 岳娜, 崔兰英, 李刚, 范会, 苏丹虹, 刘丽文, 田素飞, 赵声远, 杜雪飞, 周宏伟, 徐英春. 2012年度侵袭性真菌耐药监测网(CHIF-NET)侵袭性酵母菌感染的分布特征[J]. 中国真菌学杂志, 2021, 16(4): 234-242.

DUAN Simeng, XIAO Meng, HUANG Jingjing, WANG He, ZHANG Ge, ZHANG Jingjia, KANG Wei, WANG Tong, XIAO Yuling, NI Fang, GAO Lanmei, YE Liyan, GUO Penghao, WAN Zhe, CHEN Zhongju, YANG Qing, LIN Jie, HU Qingfeng, LI Hongling, YUE Na, CUI LanYing, LI Gang, FAN Hui, SU Danhong, LIU Liwen, TIAN Sufei, ZHAO Shengyuan, DU Xuefei, ZHOU Hongwei, XU Yingchun. Distribution characteristics of invasive yeast infections in China Hospital Invasive Fungal Surveillance Net(CHIF-NET) in 2012[J]. Chinese Journal of Mycology, 2021, 16(4): 234-242.

参考文献

[1] Ibáñez-Martínez E, Ruiz-Gaitán A, Pemán-García J. Update on the diagnosis of invasive fungal infection[J]. Rev Esp Quimioter, 2017,30(Suppl 1):16-21.
[2] Xiao M,Sun ZY,Kang M, et al. Five-year national surveillance of invasive candidiasis:Species distribution and azole susceptibility from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study[J]. J Clin Microbiol, 2018. 56(7):e00577-18.
[3] Lockhart SR, Lqbal N, Cleveland AA, et al.Species identification and antifungal susceptibility testing of Candida bloodstream isolates from population-based surveillance studies in two U.S. cities from 2008 to 2011[J]. J Clin Microbiol, 2012,50(11):3435-3442.
[4] Li F, Wu L, Cao B, et al, Surveillance of the prevalence, antibiotic susceptibility, and genotypic characterization of invasive candidiasis in a teaching hospital in China between 2006 to 2011[J]. BMC Infect Dis, 2013,13:353.
[5] Pereira GH, Müller PR, Szeszs MW, et al. Five-year evaluation of bloodstream yeast infections in a tertiary hospital:the predominance of non-C. albicans Candida species[J]. Med Mycol, 2010,48(6):839-842.
[6] Vincent JL, Rello J, Marshall J,et al. International study of the prevalence and outcomes of infection in intensive care units[J].JAMA,2009,302(21):2323-2329.
[7] Zhang L, Xiao M, Watts MR, et al. Development of fluconazole resistance in a series of Candida parapsilosis isolates from a persistent candidemia patient with prolonged antifungal therapy[J]. BMC Infect Dis, 2015, 15:340.
[8] Andes D, Forrest A, Lepak A, et al. Impact of antimicrobial dosing regimen on evolution of drug resistance in vivo:fluconazole and Candida albicans[J]. Antimicrob Agents Chemother, 2006. 50(7):2374-2383.
[9] Barchiesi F,Calabrese D,Sanglard D, et al. Experimental induction of fluconazole resistance in Candida tropicalis ATCC 750[J]. Antimicrob Agents Chemother, 2000, 44(6):1578-1584.
[10] Wingard JR, Merz WG, Rinaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole[J]. N Engl J Med, 1991,325(18):1274-1277.
[11] Wingard JR, Merz WG, Rinaldi MG,et al. Association of Torulopsis glabrata infections with fluconazole prophylaxis in neutropenic bone marrow transplant patients[J]. Antimicrob Agents Chemother, 1993, 37(9):1847-1849.
[12] Perlin DS. Resistance to echinocandin-class antifungal drugs[J]. Drug Resist Updat, 2007,10(3):121-130.
[13] Franz R, Kelly SL, Lamb DC, et al. Multiple molecular mechanisms contribute to a stepwise development of fluconazole resistance in clinical Candida albicans strains[J]. Antimicrob Agents Chemother, 1998,42(12):3065-3072.

[1]	郝小康, 王宇鹤, 徐世林, 李楠. 土槿乙酸与氟康唑联合抗白念珠菌作用的研究[J]. 中国真菌学杂志, 2021, 16(4): 262-265.
[2]	黄进宝, 兰长青, 翁恒, 林清华. 肋骨隐球菌感染2例报道并文献复习[J]. 中国真菌学杂志, 2020, 15(5): 278-282.
[3]	赵颖, 李志荣, 赵建宏, 栗方, 董爱英, 刘金禄, 郭彦言, 谢守军, 吴相锟, 郭秀华, 王建升, 张金艳, 刘冬青, 魏宏莲, 孙艳, 赵文申, 任宏涛, 郭映辉, 肖盟, 徐英春, 徐晓琳, 王军爽, 杨文航. 河北地区临床实验室丝状真菌分离鉴定情况分析[J]. 中国真菌学杂志, 2020, 15(4): 206-212.
[4]	刘庆华, 王成, 胡芸倩, 董雪, 李强. 普通裂褶菌致肺部感染1例[J]. 中国真菌学杂志, 2020, 15(3): 173-174.
[5]	张敬霞, 崔恩博, 张鞠玲, 郭莉娜, 徐英春, 曲芬. 肝病患者无菌部位酵母菌感染的临床特征及抗真菌药物的敏感性分析[J]. 中国真菌学杂志, 2020, 15(1): 15-21.
[6]	刘文丽, 吴迪, 陈爱明, 苏万通, 鲍邦龙. 热带念珠菌致下肢皮肤感染1例并文献复习[J]. 中国真菌学杂志, 2019, 14(6): 369-370.
[7]	栗方, 李志荣, 赵建宏, 赵颖, 张延海, 董爱英, 刘金禄, 郭彦言, 孙艳, 赵文申, 谢守军, 魏宏莲, 张金艳, 任宏涛, 王建升, 吴相锟, 光晓, 刘冬青, 杜红丽, 郭映辉, 徐英春, 肖盟, 杨文航, 徐晓琳. 2016~2017年河北地区侵袭性真菌感染的病原菌分布特征[J]. 中国真菌学杂志, 2019, 14(5): 257-263.
[8]	蔡晴, 杨连娟, 高志琴, 任弘瑾, 杨虹, 谭静文. 罗米地辛对氟康唑体外抗白念珠菌影响的研究[J]. 中国真菌学杂志, 2019, 14(4): 200-203,216.
[9]	薛强, 雷岩, 张超, 廖万清, 侯立军. 2000~2019年中国大陆地区脑曲霉病回顾性分析[J]. 中国真菌学杂志, 2019, 14(3): 134-140.
[10]	刘飞飞, 王彦, 陈荣, 沈建箴. 国内静脉注射伏立康唑和氟康唑预防真菌感染临床疗效和安全性比较的Meta分析[J]. 中国真菌学杂志, 2019, 14(3): 159-163.
[11]	吴先伟, 邓秀娥, 汪舰笛. 艾氟康唑治疗甲真菌病的疗效和安全性[J]. 中国真菌学杂志, 2019, 14(3): 180-182.
[12]	雷岩, 方伟, 张超, 廖万清. 体外棋盘法分析粗糠柴苦素与氟康唑联合抗隐球菌作用[J]. 中国真菌学杂志, 2019, 14(2): 90-94.
[13]	刘飞飞, 王琴琴, 王玙, 沈建箴. 口服氟康唑联合克霉唑栓治疗念珠菌性阴道炎临床疗效的meta分析[J]. 中国真菌学杂志, 2018, 13(5): 257-261.
[14]	王玉连, 袁公, 陈雅楠, 曹永兵, 吴建华. 利福喷丁联合氟康唑对耐药白念珠菌细胞周期的影响[J]. 中国真菌学杂志, 2018, 13(3): 144-147.
[15]	王若珺, 李若瑜, 王爱平. 外用抗真菌药物治疗甲真菌病进展[J]. 中国真菌学杂志, 2018, 13(2): 114-119.