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Geographic variation in the frequency of isolation and fluconazole and voriconazole susceptibilities of Candida glabrata: an assessment from the ARTEMIS DISK Global Antifungal Surveillance Program.
不同地域光滑假丝酵母菌的检出率以及对氟康唑和伏立康唑敏感性的不同:一项来自ARTEMIS DISK 全球抗真菌调查项目的评估

出处: Diagn Microbiol Infect Dis   2010   Jun   67 (2) :162-71

作者:Pfaller MA;Diekema DJ;Gibbs DL;Newell VA;Barton R;Bijie H;Bille J;Chang SC;da Luz Martins M;Duse A;Dzierzanowska D;Ellis D;Finquelievich J;Gould I;Gur D;Hoosen A;Lee K;Mallatova N;Mallie M;Peng NG;Petrikos G;Santiago A;Trupl J;VanDen Abeele AM;Wadula J;Zaidi M

PMID:20338711

Geographic differences in frequency and azole resistance among Candida glabrata may impact empiric antifungal therapy choice. We examined geographic variation in isolation and azole susceptibility of C. glabrata. We examined 23 305 clinical isolates of C. glabrata during ARTEMIS DISK global surveillance. Susceptibility testing to fluconazole and voriconazole was assessed by disk diffusion, and the results were grouped by geographic location: North America (NA) (2470 isolates), Latin America (LA) (2039), Europe (EU) (12 439), Africa and the Middle East (AME) (728), and Asia-Pacific (AP) (5629). Overall, C. glabrata accounted for 11.6% of 201 653 isolates of Candida and varied as a proportion of all Candida isolated from 7.4% in LA to 21.1% in NA. Decreased susceptibility (S) to fluconazole was observed in all geographic regions and ranged from 62.8% in AME to 76.7% in LA. Variation in fluconazole susceptibility was observed within each region: AP (range, 50-100% S), AME (48-86.9%), EU (44.8-88%), LA (43-92%), and NA (74.5-91.6%). Voriconazole was more active than fluconazole (range, 82.3-84.2% S) with similar regional variation. Among 22 sentinel sites participating in ARTEMIS from 2001 through 2007 (84 140 total isolates, 8163 C. glabrata), the frequency of C. glabrata isolation increased in 14 sites and the frequency of fluconazole resistance (R) increased in 11 sites over the 7-year period of study. The sites with the highest cumulative rates of fluconazole R were in Poland (22% R), the Czech Republic (27% R), Venezuela (27% R), and Greece (33% R). C. glabrata was most often isolated from blood, normally sterile body fluids and urine. There is substantial geographic and institutional variation in both frequency of isolation and azole resistance among C. glabrata. Prompt species identification and fluconazole susceptibility testing are necessary to optimize therapy for invasive candidiasis.

光滑假丝酵母菌检出率以及对唑类耐药的地区差异会影响经验性抗真菌治疗药物的选择。我们检验了不同地区光滑假丝酵母菌的分离检出率以及对唑类的敏感性。在ARTEMIS DISK全球调查期间,我们检测了23305株临床分离的光滑假丝酵母菌。通过纸片扩散法评估菌株对氟康唑和伏立康唑的敏感性,结果按地域进行分组:北美洲(2470株),拉丁美洲(2039株),欧洲(12,439),非洲和中东地区(728株),亚洲-太平洋地区(5629株)。总体上,光滑假丝酵母菌占到分离出的201,653株念珠菌的11.6%,这一比例在不同地区有所差异,拉丁美洲为7.4%,北美洲为21.1%。在所有观察的地区对氟康唑的敏感性都是下降的,非洲和中东地区敏感率62.8%,拉丁美洲76.7%。对氟康唑的敏感性在同一地区内部也是不同的:亚太地区(范围50-100%),非洲和中东地区(48-86.9%), 欧洲(44.8-88%),拉丁美洲(43-92%),北美洲(74.5-91.6%)。 在同一地区伏立康唑活性要比氟康唑强(范围82.3-84.2%)。2001年到2007年间,在参加ARTEMIS的22个哨点中14个哨点检出光滑假丝酵母菌的频率增加,并且有11个哨点氟康唑耐药率增加。累积氟康唑耐药率最高的地区是波兰(22%), 捷克(27%), 委内瑞拉(27%)和希腊(33%)。光滑假丝酵母菌主要从血液、正常无菌体液和尿液中分离出。在不同地域和机构,光滑假丝酵母菌的检出率和对唑类的耐药性明显不同。迅速的菌群鉴定和氟康唑敏感性测定对于侵袭性念珠菌病的最佳治疗是必要的。