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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (4): 83-93.doi: 10.6040/j.issn.1671-7554.0.2024.0470

• 临床医学 • 上一篇    

2018—2021年山东省儿童与成人临床分离真菌的构成与主要菌种的体外抗真菌药物敏感性监测

王梦园,张春艳,于文文,寇琳娜,王世富   

  1. 山东大学附属儿童医院临床微生物科, 山东 济南 250022
  • 发布日期:2025-04-08
  • 通讯作者: 王世富. E-mail:wshfu709@163.com
  • 基金资助:
    济南市卫生健康委员会科技发展项目(2022-1-45)

Composition and antifungal susceptibility surveillance of clinically isolated fungi from children and adults in Shandong Province from 2018 to 2021

WANG Mengyuan, ZHANG Chunyan, YU Wenwen, KOU Linna, WANG Shifu   

  1. Clinical Microbiology Department, Childrens Hospital Affiliated to Shandong University, Jinan 250022, Shandong, China
  • Published:2025-04-08

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摘要： 目的 对2018年至2021年山东省临床分离的真菌进行监测,比较儿童与成人患者分离真菌的构成与药物敏感性。 方法 基于山东省儿童细菌&真菌耐药监测网(Shandong Province pediatric bacterial & fungal antimicrobial resistance surveillance system, SPARSS),收集2018年至2021年山东省47所综合医院、11所妇幼保健医院及1所儿童医院临床分离真菌的信息,使用WHONET V5.6软件分析不同人群的真菌构成及药物敏感性情况。 结果 共收集真菌15 348株,其中95.5%分离于成人,4.5%分离于儿童。分离的真菌主要为念珠菌(78.4%)和曲霉菌(17.8%)。念珠菌以白念珠菌(41.8%)、热带念珠菌(22.7%)、光滑念珠菌(17.5%)和近平滑念珠菌(11.0%)为主;曲霉菌以烟曲霉(53.7%)、黄曲霉(15.3%)和黑曲霉(7.2%)为主。分离自成人的前五位真菌为白念珠菌(32.1%)、热带念珠菌(18.1%)、光滑念珠菌(14.0%)、烟曲霉(9.8%)和近平滑念珠菌(8.5%);分离自儿童的前五位真菌为白念珠菌(47.3%)、热带念珠菌(11.2%)、近平滑念珠菌(10.6%)、光滑念珠菌(6.8%)和烟曲霉(4.4%)。无菌标本分离的真菌共1 989株,以念珠菌(90.2%)和隐球菌(4.3%)为主。4年间,成人分离的真菌构成无明显的变化趋势,儿童分离的白念珠菌占比降低而非白念珠菌占比升高,腹腔积液分离的白念珠菌占比由2018年的61.8%降至2021年的46.2%。大多数念珠菌对两性霉素B敏感性较高,野生型率均>97%。对唑类药物的敏感性差异较大:白念珠菌和近平滑念珠菌对氟康唑和伏立康唑的敏感率分别为91.7%/84.7%和91.6%/87.4%,热带念珠菌对氟康唑和伏立康唑的敏感率分别为67.8%和40.6%。2018至2021年,热带念珠菌对唑类药物的敏感性持续降低,对氟康唑和伏立康唑的敏感率从2018年的70.4%/46.4%降至2021年的65.3%/35.2%。分离自儿童与成人的部分念珠菌对唑类药物的耐药性存在差异,分离自儿童的热带念珠菌对氟康唑和伏立康唑的耐药率分别为40.6%和32.8%,高于成人分离株的27.4%和23.2%;分离自儿童的光滑念珠菌对氟康唑和伏立康唑的耐药率/非野生型率分别为16.2%和25.7%,高于成人分离株的3.4%和18.0%。 结论 山东省临床分离的真菌以念珠菌和曲霉菌为主,成人与儿童的菌种构成和药物敏感性存在差异,儿童患者白念珠菌占比逐年下降的趋势及其非白念珠菌对唑类药物更高的耐药率使得儿童真菌耐药的形势更加严峻。此外,热带念珠菌对氟康唑敏感率的逐年下降亦值得关注并采取对应措施。

关键词: 真菌, 体外抗真菌药物敏感性试验, 成人, 儿童, 唑类, 热带念珠菌

Abstract: Objective To monitor the clinically isolated fungi in Shandong Province from 2018 to 2021, and compare the difference in composition and antifungal drug sensitivity of isolated fungi between children and adults. Methods Based on the Shandong Province pediatric bacterial & fungal antimicrobial resistance surveillance system(SPARSS), clinical isolation fungal information from 47 comprehensive hospitals, 11 maternal and child health hospitals, and 1 childrens hospital in Shandong Province from 2018 to 2021 was collected, and WHONET V5.6 software was used to analyze the composition and drug sensitivity of fungi in different populations. Results A total of 15,348 strains of fungi were collected, of which 95.5% were isolated from adults and 4.5% from children. The predominant fungi isolated were Candida(78.4%)and Aspergillus(17.8%). Among the Candida isolates, C. albicans(41.8%), C. tropicalis(22.7%), C. glabrata(17.5%), and C. parapsilosis(11.0%)were the most common, while Aspergillus isolates were predominantly composed of A. fumigatus(53.7%), A. flavus(15.3%), and A. niger(7.2%). The top five fungi isolated from adults were C. albicans(32.1%), C. tropicalis(18.1%), C. glabrata(14.0%), A. fumigatus(9.8%)and C. parapsilosis(8.5%). For children, the top five isolated fungi were C. albicans(47.3%), C. tropicalis(11.2%), C. parapsilosis(10.6%), C. glabrata(6.8%), and A. fumigatus(4.4%). A total of 1,989 fungal isolates were obtained from sterile specimens, predominantly composed of Candida(90.2%)and Cryptococcus(4.3%). During the 4 years, no significant trend was observed in the fungal composition from adults. However, among the isolates from children, there was a decrease in the proportion of C. albicans and an increase in non-albicans Candida. Overall, the proportion of abdominal dropsy isolates identified as C. albicans decreased from 61.8% in 2018 to 46.2% in 2021. Most Candida species exhibited high sensitivity to amphotericin B, with wild-type rates exceeding 97%. Candida species varied significantly in their susceptibility to azoles, with the susceptibility rates of C. albicans and C. parapsilosis to fluconazole and voriconazole were 91.7%/84.7% and 91.6%/87.4%, respectively, while C. tropicalis were 67.8% and 40.6%. C. tropicalis showed a sustained decrease in susceptibility to azoles, with susceptibility rates to fluconazole and voriconazole decreased from 70.4%/46.4% in 2018 to 65.3%/35.2% in 2021. The resistance of some Candida species from children and adults to azoles was different. The resistance rates of C. tropicalis isolated from children to fluconazole and voriconazole were 40.6% and 32.8%, higher than 27.4% and 23.2% in adult isolates. The resistance/non-wild type rates of C. glabrata isolated from children to fluconazole and voriconazole were 16.2% and 25.7%, higher than 3.4% and 18.0% in adult isolates. Conclusion In Shandong Province, Candida and Aspergillus are the predominant fungi isolated. There are differences in the fungal species composition and drug sensitivity between adults and children. The declining trend of C. albicans in pediatric patients and the higher resistance of non-albicans Candida to azoles contribute to a more critical situation of antifungal resistance in pediatric fungi. Additionally, the annual decrease in susceptibility of C. tropicalis to fluconazole also warrants attention and corresponding measures.

Key words: Fungi, In vitro antifungal susceptibility test, Adult, Children, Azoles, Candida tropicalis

中图分类号: 

  • R379
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