全国多中心血流分离近平滑念珠菌药物敏感性和分子流行病学回顾性研究

中国真菌学杂志　 2021, Vol. 16 　Issue (5): 289-295.

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全国多中心血流分离近平滑念珠菌药物敏感性和分子流行病学回顾性研究

张丽^1,2, 于淑颖^1,2,3, 宁雅婷^1,2,3, 肖盟^1,2, 肖玉玲⁴, 崔兰英⁵, 陈中举⁶, 严岩⁷, 叶丽艳⁸, 徐英春^1,2

1. 中国医学科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. 中国医学科学院北京协和医学院, 北京 100730;
4. 四川大学华西医院实验医学科, 成都 610041;
5. 哈尔滨医科大学附属第一医院检验科, 哈尔滨 150001;
6. 华中科技大学同济医学院附属同济医院检验科, 武汉 430030;
7. 北京大学第一医院检验科, 北京 100034;
8. 解放军总医院第一医学中心医学检验中心, 北京 100853

收稿日期:2021-04-07 发布日期:2021-10-28
通讯作者: 徐英春,E-mail:xycpumch@139.com E-mail:xycpumch@139.com
作者简介:张丽,女(汉族),博士,主管技师.E-mail:zhanglipumchlab@163.com
基金资助:
国自然科学基金（81802049，81572057）；北京市临床重点专科医学检验科卓越项目（ZK201000）

Multicenter retrospective study on antifungal susceptibility and molecular epidemiology of Candida parapsilosis isolated from bloodstream infections in China

ZHANG Li^1,2, YU Shuying^1,2,3, NING Yating^1,2,3, XIAO Meng^1,2, XIAO Yuling⁴, CUI Lanying⁵, CHEN Zhongju⁶, YAN Yan⁷, YE Liyan⁸, 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 Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing 100730, China;
3. Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;
4. Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China;
5. Department of Laboratory, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China;
6. Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
7. Clinical Laboratory, Peking University First Hospital, Beijing 100034, China;
8. Clinical Laboratory Center, Chinese PLA General Hospital, Beijing 100853, China

Received:2021-04-07 Published:2021-10-28

摘要/Abstract

摘要： 目的对全国多中心收集的血流感染近平滑念珠菌进行分子流行病学和药物敏感性分析。方法将全国42家医院377例血流感染患者中分离的非重复菌株纳入研究，采用美国临床和实验室标准协会（CLSI） M44-A2纸片扩散法进行氟康唑和伏立康唑敏感性检测，采用微卫星分型方法对所有菌株进行分子流行病学分析。结果 377例患者中，46.2%的患者年龄超过60岁；分别有26.5%、23.9%、21.8%和12.5%的患者分布于外科病房、内科病房、综合ICU和外科ICU病房。377株近平滑念珠菌中，24株（6.4%）对氟康唑耐药，10株（2.7%）对伏立康唑耐药。微卫星分型结果显示，所有菌株共分为172个微卫星型别（microsatellite genotype，MT），125个MT型别各自仅在单个菌株中出现；28家医院内经分析存在65例同家医院内不同患者感染同型别菌株的情况，其中同型别氟康唑耐药株在同家医院内感染不同患者的情况为6例。结论本研究回顾分析全国多中心血流感染近平滑念珠菌的分子流行病学，在多家医院内均发现同型别菌株包括氟康唑耐药菌株分离于不同患者的情况，提示存在近平滑念珠菌院内传播的可能。

关键词: 近平滑念珠菌, 血流感染, 分子流行病学, 微卫星分型, 耐药

Abstract: Objectives The present study was to conduct molecular epidemiology and antifungal susceptibilities of C. parapsilosis retrospectively based on multicenter isolates nationwide in China. Methods Atotal of 377 non-duplicated C. parapsilosis isolates from bloodstream infections were collected from unique patients from 42 hospitals across China. Antifungal susceptibility to fluconazole and voriconazole was determined for all isolates using the CLSI M44-A2 disc diffusion method. C. parapsilosis isolates were genotyped using four highly polymorphic microsatellite markers. Results Of the 377 patients, 46.2% were over 60 years old. 26.5%, 23.9%, 21.8% and 12.5% patients were located in surgical ward, medicine ward, general ICU and surgical ICU respectively. Among 377 strains, 24 (6.4%) were resistant to fluconazole and 10 (2.7%) to voriconazole. Microsatellite typing showed that all strains were divided into 172 microsatellite types, 125 MT types only appeared in a single strain; in 28 hospitals, there were 65 cases of which different patients in the same hospital were infected with the same MT type of strains, among which 6 cases indicated different patients were infected with the same MT type of fluconazole resistant strains in the same hospital. Conclusions Here we presented the nationwide molecular epidemiology study of C. parapsilosis causing bloodstream infections in China, and identified several cases of which different patients in the same hospital were infected with the same MT type of strains including antifungal resistant isolates, indicating probable horizontal transmission of C. parapsilosis in hospitals.

Key words: Candida parapsilosis, bloodstream infection, molecular epidemiology, microsatellite typing, antifungal resistance

中图分类号:

R519.3

张丽, 于淑颖, 宁雅婷, 肖盟, 肖玉玲, 崔兰英, 陈中举, 严岩, 叶丽艳, 徐英春. 全国多中心血流分离近平滑念珠菌药物敏感性和分子流行病学回顾性研究[J]. 中国真菌学杂志, 2021, 16(5): 289-295.

ZHANG Li, YU Shuying, NING Yating, XIAO Meng, XIAO Yuling, CUI Lanying, CHEN Zhongju, YAN Yan, YE Liyan, XU Yingchun. Multicenter retrospective study on antifungal susceptibility and molecular epidemiology of Candida parapsilosis isolated from bloodstream infections in China[J]. Chinese Journal of Mycology, 2021, 16(5): 289-295.

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全国多中心血流分离近平滑念珠菌药物敏感性和分子流行病学回顾性研究

Multicenter retrospective study on antifungal susceptibility and molecular epidemiology of Candida parapsilosis isolated from bloodstream infections in China

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