真菌病原抗藥性監測暨真菌藥敏試驗方法評估計畫

Monitoring the Antimicrobial Resistance of Pathogenic Fungus and Verification of the Antifungal Susceptibility Test

近年來由於廣效性抗微生物製劑的大量使用及免疫低下病患族群的增加，使得伺機性病原如酵母菌的感染增加。念珠菌(Candida spp.)在國內外均已是造成醫療照護相關血流感染的主要病原，使得抗真菌藥物抗藥性的控制更受重視。念珠菌對不同抗真菌藥物具有不同的感受程度，且存在地區性及時間性的差異。本計畫主要目的為進行本院念珠菌臨床分離株的藥物敏感性試驗，藉此建立不同菌種抗藥性資料庫，以提供臨床醫師用藥參考，並監測本院真菌抗藥性狀況。結果顯示針對98隻臨床念珠菌分離株當中，C. albicans對所測試的抗真菌藥物皆呈現susceptible，而C. glabrata及C. tropicalis對azoles藥物的抗藥性比例都較C. albicans高，且對於不同種類的azoles類藥物其感受性程度也較不一致。此外，本次研究也針對兩種市售抗真菌藥敏系統：Sensititre YeastOne (Trek Diagnostic Systems)及ATB Fungus 3 (bioMérieux Clinical Diagnostics)比較兩者之表現。YeastOne測試組完整提供目前臨床常用九種抗真菌藥物藥敏結果，操作方便且可提供更客觀判讀方式，其應用性也優於ATB Fungus 3，更適合用於臨床實驗室。

Because of the abuse of extended antimicrobial agents and the increasing number of immunocompromised patients, infections caused by opportunistic pathogens, such as yeast, have increased significantly. As Candida species have become a prominent cause of nosocomial bloodstream infections, the emergence of antifungal resistance has become an important public health problem. Since antifungal susceptibilities may differ in different geographical areas and over time, surveillance reports for detection of resistance patterns are encouraged.The aim of this study was to test the antifungal susceptibilities of clinical Candida isolates, understand the resistance pattern of these pathogens and establish a database of antifungal susceptibilities to offer clinicians choices for empirical treatment when fungal infection is suspected. Our results indicate that C. albicans are susceptible to all the tested antifungal drugs. C. glabrara and C. tropicalis are more resistant to these antifungal agents than C. albicans and have different susceptibility patterns among fluconazole, itraconazole, and voriconazole. In addition, we evaluated the performance of two commercial systems, Sensititre YeastOne (Trek Diagnostic Systems) and ATB Fungus 3 (bioMérieux Clinical Diagnostics). YeastOne can provide an easy set-up procedure and reliable endpoint determinations. It is potentially useful for antifungal susceptibility testing of yeasts in clinical laboratories.