대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)

  • 제54권2호
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  • Pages.133-141
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  • 2022
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  • 1738-3544(pISSN)
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  • 2288-1662(eISSN)
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)
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2009~2018년 혈액배양으로부터 분리된 Candida 균종의 항진균제 감수성의 경향

Trends of Antifungal Agent Susceptibility of Candida Strains Isolated from Blood Cultures in 2009~2018

  • 황유연 (삼성서울병원 진단검사의학과) ;
  • 강온균 (삼성서울병원 진단검사의학과) ;
  • 박창은 (남서울대학교 임상병리학과.분자진단연구소) ;
  • 이무식 (건양대학교 보건복지대학원 보건학과) ;
  • 김영권 (건양대학교 보건복지대학원 보건학과) ;
  • 허희재 (성균관대학교 의과대학 삼성서울병원 진단검사의학과) ;
  • 이남용 (성균관대학교 의과대학 삼성서울병원 진단검사의학과)
  • Hwang, Yu-Yean (Department of Laboratory Medicine, Samsung Medical Center) ;
  • Kang, On-Kyun (Department of Laboratory Medicine, Samsung Medical Center) ;
  • Park, Chang-Eun (Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University) ;
  • Lee, Moo-Sik (Department of Health Sciences, The Graduate School of Konyang University) ;
  • Kim, Young-Kwon (Department of Health Sciences, The Graduate School of Konyang University) ;
  • Huh, Hee-Jae (Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Nam-Yong (Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2022.04.06
  • 심사 : 2022.05.24
  • 발행 : 2022.06.30
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초록

혈류 감염(BSI)의 주요 원인균의 하나로 입원환자에서 이환율과 사망률을 높이는 칸디다의 항진균제 내성률을 조사하여 칸디다 혈증(candidemia)의 경험적 치료 방침에 중요한 정보를 제공하고자 한다. 2009~2018년 S병원의 혈액배양 검사에서 분리된 Candida 균주(973건) 중 Candida spp. (932 균주)에 대한 fluconazole 감수성 시험결과에서 4.7% (N=44)가 내성(resistant, R)을 보였고 C. albicans, C. parapsilosis, C. tropicalis, C. glabrata에서 내성 균주를 확인하였다. 또한, Candida spp. (947 균주)의 amphotericin B에 대한 감수성 결과에서는 내성(N=6, 0.6%)이 나타났고, 전체 Candida spp.(973 균주)에 대한 flucytosine 감수성 시험에서는 내성(N=23, 2.4%)을 보였다. Candida spp. (768 균주)의 voriconazole에 대한 감수성 시험에서는 내성(N=24, 3.1%)을 보였다. C. albicans는 fluconazole (N=23, 6.9%), voriconazole (N=21, 6.0%)이 내성이고 통계학적으로 C. albicans과 non-albicans Candida species은 fluconazole (P=0.039), voriconazole (P<0.001)로 나타났다. 칸디다 혈증의 감염률을 이해하고 예방하기 위한 감시 시스템이 요구되고 항진균제의 적절한 투여와 치료가 요구된다. 따라서 항진균제 감수성 결과의 모니터링을 통한 칸디다의 내성을 추적하는 감염감시활동 정책이 필요할 것으로 사료된다.

Candida is one of the most common causes of bloodstream infections and a leading cause of morbidity and mortality among hospitalized patients. The purpose of this study was to provide important information for formulating empirical treatment plans for candidemia by investigating the antifungal resistance rate of Candida. Among the Candida strains (973 cases) isolated from blood culture tests at the S hospital in 2009~2018, 4.7% (N=44) comprising the Candida spp. (932 strains) showed resistance to fluconazole. The resistant strains included C. albicans, C. parapsilosis, C. tropicalis, and C. glabrata. In addition Candida spp. (947 strains) showed resistance to amphotericin B (N=6, 0.6%), flucytosine (N=23, 2.4%) and voriconazole (N=24, 3.1%). C. albicans was resistant to fluconazole (N=23, 6.9%) and voriconazole (N=21, 6.0%), The statistical analysis showed that C. albicans and non-albicans Candida species were resistant to fluconazole (P=0.039) and voriconazole (P<0.001). A monitoring system to understand the rate of candidiasis infections in a hospital setting is required. It is also important to make the right choice of the antifungal agent based on drug susceptibility patterns. Therefore, an infection surveillance policy that tracks Candida resistance through regular antifungal susceptibility tests is necessary.

키워드

과제정보

This article is article is a revision of the first author's master's thesis from University.

참고문헌

  1. Lopez Dupla M, Martinez JA, Vidal F, Almela M, Lopez J, Marco F, et al. Clinical characterization of breakthrough bacteraemia: a survey of 392 episodes. J Intern Med. 2005;258:172-180. https://doi.org/10.1111/j.1365-2796.2005.01513.x
  2. Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013;19:501-509. https://doi.org/10.1111/1469-0691.12195
  3. Trecarichi EM, Pagano L, Candoni A, Pastore D, Cattaneo C, Fanci R, et al. Current epidemiology and antimicrobial resistance data for bacterial bloodstream infections in patients with hematologic malignancies: an Italian multicentre prospective survey. Clin Microbiol Infect. 2015;21:337-343. https://doi.org/10.1016/j.cmi.2014.11.022
  4. Antinori S, Milazzo L, Sollima S, Galli M, Corbellino M. Candidemia and invasive candidiasis in adults: A narrative review. Eur J Intern Med. 2016;34:21-28. https://doi.org/10.1016/j.ejim.2016.06.029
  5. Bassetti M, Righi E, Ansaldi F, Merelli M, Trucchi C, De Pascale G, et al. A multicenter study of septic shock due to candidemia: outcomes and predictors of mortality. Intensive Care Med. 2014;40:839-845. https://doi.org/10.1007/s00134-014-3310-z
  6. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309-317. https://doi.org/10.1086/421946
  7. Kim JS, Gong SY, Kim JW, Rheem I, Kim GY. Antimicrobial susceptibility patterns of microorganisms isolated from blood culture during the last 8 years: 2010-2017. Korean J Clin Lab Sci. 2019;51:155-163. https://doi.org/10.15324/kjcls.2019.51.2.155
  8. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1-e50. https://doi.org/10.1093/cid/civ933
  9. Horn DL, Fishman JA, Steinbach WJ, Anaissie EJ, Marr KA, Olyaei AJ, et al. Presentation of the PATH Alliance registry for prospective data collection and analysis of the epidemiology, therapy, and outcomes of invasive fungal infections. Diagn Microbiol Infect Dis. 2007;59:407-414. https://doi.org/10.1016/j.diagmicrobio.2007.06.008
  10. Kett DH, Azoulay E, Echeverria PM, Vincent JL; Extended Prevalence of Infection in ICU Study (EPIC II) Group of Investigators. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Crit Care Med. 2011;39:665-670. https://doi.org/10.1097/CCM.0b013e318206c1ca
  11. Colombo AL, Guimaraes T, Sukienik T, Pasqualotto AC, Andreotti R, Queiroz-Telles F, et al. Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period. Intensive Care Med. 2014;40:1489-1498. https://doi.org/10.1007/s00134-014-3400-y
  12. Rex JH, Walsh TJ, Sobel JD, Filler SG, Pappas PG, Dismukes WE, et al. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis. 2000;30:662-678. https://doi.org/10.1086/313749
  13. St-Germain G, Laverdiere M, Pelletier R, Bourgault AM, Libman M, Lemieux C, et al. Prevalence and antifungal susceptibility of 442 Candida isolates from blood and other normally sterile sites: results of a 2-year (1996 to 1998) multicenter surveillance study in Quebec, Canada. J Clin Microbiol. 2001;39:949-953. https://doi.org/10.1128/JCM.39.3.949-953.2001
  14. Chakrabarti A, Sood P, Rudramurthy SM, Chen S, Kaur H, Capoor M, et al. Incidence, characteristics and outcome of ICU-acquired candidemia in India. Intensive Care Med. 2015;41:285-295. https://doi.org/10.1007/s00134-014-3603-2
  15. Cleveland AA, Harrison LH, Farley MM, Hollick R, Stein B, Chiller TM, et al. Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US metropolitan areas, 2008-2013: results from population-based surveillance. PLoS One. 2015;10:e0120452. https://doi.org/10.1371/journal.pone.0120452
  16. Hesstvedt L, Gaustad P, Andersen CT, Haarr E, Hannula R, Haukland HH, et al. Twenty-two years of candidaemia surveillance: results from a Norwegian national study. Clin Microbiol Infect. 2015;21:938-945. https://doi.org/10.1016/j.cmi.2015.06.008
  17. Vallabhaneni S, Mody RK, Walker T, Chiller T. The global burden of fungal diseases. Infect Dis Clin North Am. 2016;30:1-11. https://doi.org/10.1016/j.idc.2015.10.004
  18. Rex JH, Pappas PG, Karchmer AW, Sobel J, Edwards JE, Hadley S, et al. A randomized and blinded multicenter trial of high-dose fluconazole plus placebo versus fluconazole plus amphotericin B as therapy for candidemia and its consequences in nonneutropenic subjects. Clin Infect Dis. 2003;36:1221-1228. https://doi.org/10.1086/374850
  19. Lackner M, de Hoog GS, Verweij PE, Najafzadeh MJ, Curfs-Breuker I, Klaassen CH, et al. Species-specific antifungal susceptibility patterns of Scedosporium and Pseudallescheria species. Antimicrob Agents Chemother. 2012;56:2635-2642. https://doi.org/10.1128/AAC.05910-11
  20. WHO. Antimicrobial Resistance: Global Report on Surveillance [Internet]. 2014. [cited 2022 January 22]. Available from: https://apps.who.int/iris/handle/10665/112642
  21. Pfaller MA, Diekema DJ, Jones RN, Sader HS, Fluit AC, Hollis RJ, et al. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and in vitro susceptibilities to fluconazole, ravuconazole, and Voriconazole of isolates collected from 1997 through 1999 in the SENTRY antimicrobial surveillance program. J Clin Microbiol. 2001;39:3254-3259. https://doi.org/10.1128/JCM.39.9.3254-3259.2001
  22. Chae MJ, Shin JH, Cho D, Kee SJ, Kim SH, Shin MG, et al. Antifungal susceptibilities and distribution of Candida species recovered from blood cultures over an 8-year period. Korean J Lab Med. 2003;23:329-335.
  23. Khan Z, Ahmad S, Al-Sweih N, Mokaddas E, Al-Banwan K, Alfouzan W, et al. Changing trends in epidemiology and antifungal susceptibility patterns of six bloodstream Candida species isolates over a12-year period in Kuwait Ziauddin Khan. PLOS one. 2019;14:e0216250. https://doi.org/10.1371/journal.pone.0216250
  24. Rodriguez L, Bustamante B, Huaroto L, Agurto C, Illescas R, RamirezR, et al. A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes. PLoS One. 2017;12:e0175172. https://doi.org/10.1371/journal.pone.0175172
  25. World Health Organization. Antimicrobial resistance global report on surveillance 2014 [Internet]. [cited 2022 January 14]. Available from: https://apps.who.int/iris/bitstream/handle/10665/112647/WHO_HSE_PED_AIP_2014.2_eng.pdf
  26. Vallabhaneni S, Cleveland AA, Farley MM, Harrison LH, Schaffner W, Beldavs ZG, et al. Epidemiology and risk factors for echinocandin nonsusceptible Candida glabrata bloodstream infections: data from a large multisite population-based candidemia surveillance program, 2008-2014. Open Forum Infect Dis. 2015;2:ofv163. https://doi.org/10.1093/ofid/ofv163
  27. Healey KR, Zhao Y, Perez WB, Lockhart SR, Sobel JD, Farmakiotis D, et al. Prevalent mutator genotype identified in fungal pathogen Candida glabrata promotes multi-drug resistance. Nat Commun. 2016;7:11128. https://doi.org/10.1038/ncomms11128
  28. Cho EJ, Shin JH, Kim SH, Kim HK, Park JS, Sung H, et al. Emergence of multiple resistance profiles involving azoles, echinocandins and Amphotericin B in Candida glabrata isolates from a neutropenia patient with prolonged fungaemia. J Antimicrob Chemother. 2015;70:1268-1270. https://doi.org/10.1093/jac/dku518