2010年台灣黴菌抗藥性監測計畫和共生於愛滋病患口腔中黴菌的分布與對抗黴菌製劑的感受性

Abstract

有鑑於念珠菌產生的抗藥性已日益嚴重，故本論文藉由 2010台灣黴菌抗藥性監測觀察念珠菌分布及對藥物感受性。收集由全台灣24家醫院的檢體所分離出的1124個臨床菌株中，Candida albicans 佔全體 38.0％ (427/1124)，其次依序為 23.8％ Candida tropicalis (267/1124)，23.0％ Candida glabrata (258/1124)，7.9％ Candida parapsilosis (89/1124)，1.6％ Candida krusei (18/1124)，和25種其它種類的菌5.8％ (65/1124)。其中受到黴菌菌株感染的部位以尿液比例最高(45.8％)，其次分別為血液(19.4％)和痰液(12.8％)等。利用肉湯稀釋法進行藥物感受性，根據美國臨床實驗室國家標準委員會 (CLSI)判定標準，有89 (8.4％) 個臨床菌株對 fluconazole具抗藥性，78 (7.3％)個臨床菌株對 voriconazole具抗藥性，同時對 fluconazole 和voriconazole 皆具有抗藥性的菌株共 49 株，其中包括 44 株 C. tropicalis，3株 C. albicans，2株 C. glabrata，根據歐洲藥檢委員會 (EUCAST) 對C. albicans，C. tropicalis，C. parapsilosis的判定標準，有74 (7.9％) 個臨床菌株對 fluconazole具抗藥性，48 (6.4％) 個臨床菌株對 voriconazole具抗藥性，同時對 fluconazole 和 voriconazole 皆具有抗藥性的菌株共23株，其中包括17株 C. tropicalis，5株 C. albicans，1株 C. parapsilosis。5 (0.5％) 株對 anidulafungin有抗藥性，1 (0.09％) 株對 amphotericin B 有抗藥性。此外，由中國醫藥大學附設醫院、義大醫院、成大醫院的愛滋病患(HIV-infected patients)口腔棉花拭子取得的716個檢體中所分離出的494個黴菌菌株中一共有25個不同的菌種，包括 70.1％ C. albicans (350/494)，依序為 8.1％ C. glabrata (40/494)，7.9％ Candida dubliniensis (39/494)，4.3％ C. tropicalis (21/494)，1.4％ C. parapsilosis (7/494)，和 7.5％ 20個其它種類的菌種 (37/494)。利用肉湯稀釋法對fluconazole其最小抑菌濃度≧64 mg/L 視為具抗藥性，有18 (4.0％) 株臨床菌株對fluconazole產生抗藥性；對voriconazole最小抑菌濃度≧4 mg/L 視為具抗藥性，有13 (2.9％) 株臨床菌株對voriconazole產生抗藥性；對amphotericin B最小抑菌濃度＞1 mg/L 視為具抗藥性，有1 (0.2％) 株臨床菌株對amphotericin B產生抗藥性。

The emergence of drug resistance by Candida species has become an important issue. To study the trend of distribution of Candida species and drug susceptibility, we have conducted Taiwan Surveillance of Antimicrobial Resistance of Yeasts in 2010. Among the 1124 isolates collected from 24 hospitals, there were 38.0％ Candida albicans (427/1124), 23.8％ Candida tropicalis (267/1124), 23.0％ Candida glabrata (258/1124), 7.9％ Candida parapsilosis (89/1124), 1.6％ Candida krusei (18/1124), and 8.37％ 25 other different species (89/1124). The most common source of infection was urine (45.8％), followed by blood (19.4％) and sputum (12.8％). The susceptibility to antifungal drugs was determined by broth microdilution methods. 89 (8.4％) of them were resistant to fluconazole and 78 (7.3％) were resistant to voriconazole. There were 49 isolates coresistant to fluconazole and voriconazole, including 44 C. tropicalis, 3 C. albicans, and 2 C. glabrata among the 1124 isolates. According to the breakpoint of Clinical and Laboratory Standards Institute (CLSI). 74 (7.9％) of the clinical isolates were resistant to fluconazole, and 48 (6.4％) of them were resistant to voriconazole. There were 23 isolates coresistant to fluconazole and voriconazole, including 17 C. tropicalis, 5 C. albicans，1 C. parapsilosis. According to the breakpoint of European committee for antimicrobial susceptibility. 5 (0.5％) of the clinical isolates were resistant to anidulafungin and 1 (0.09％) of them were resistant to amphotericin B. A total of 716 oral swabs were collected from HIV-infected patients in China Meidcal University (CMU) Hospital, E-DA Hospital, and National Cheng Kung University (NCKU) Hospital. There were 494 yeast isolates composed of 25 different species. They were 70.9％ (350/494) C. albicans, 8.1％ (40/494) C. glabrata,7.9％(39/494), Candida dubliniensis, 4.3％ (21/494) C. tropicalis, 1.4％(7/494) C. parapsilosis, and 7.5％ (37/494) consisting of 20 different species. The drug susceptibility of these isolates have been determined by broth microdilution according to the guidelines of CLSI.18 (4.0％) of clinical isolates were resistant (minimal inhibited concentration≧64 mg/L) to fluconazole, 13 (2.9％) of them were resistant(minimal inhibited concentration≧4 mg/L) to voriconazole, 1 (0.2％) were resistant (minimal inhibited concentration≧＞1 mg/L) to amphotericin B.