AUTHOR=Zeng Xuehua , Peng Mengran , Liu Guirong , Huang Yongqing , Zhang Tingting , Wen Jing , Lai Wei , Zheng Yue 

TITLE=Strain Distribution and Drug Susceptibility of Invasive Fungal Infection in Clinical Patients With Systemic Internal Diseases

JOURNAL=Frontiers in Bioengineering and Biotechnology

VOLUME=Volume 8 - 2020

YEAR=2021

URL=https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2020.625024

DOI=10.3389/fbioe.2020.625024

ISSN=2296-4185

ABSTRACT=Objective: To investigate the incidence, strain distributions, and drug susceptibility of invasive fungal strains isolated from patients with systemic internal diseases
Methods: Samples were collected from 9430 patients who were diagnosed with internal diseases in our hospital from Jan. to Dec. 2018. We then cultured and identified the fungal strains using API 20C AUX. We performed drug sensitivity analysis via the ATB Fungus-3 fungal susceptibility strip. Resistance was defined using the revised CLSI breakpoints/epidemiological cutoff values to assign susceptibility or wild type status to systemic antifungal agents.
Results: 179 patients with fungal infection were included. The high incidence departments were determined to be the Respiratory department (34.64%), Intensive Care Unit (21.79%) and Hepatology department (9.50%).The susceptible systems for infection were respiratory tract (sputum, 68.72%,123/179 , tracheal catheter, 3.35%,6/179), urinary tract (urine, 9.50%,17/179), and  gastrointestinal tract (feces, 9.50%,17/179). The major pathogens were candida (90.50%), aspergillus (8.93%), and cryptococcus neoformans (0.56%). The infective candida subgroups were C. albicans (70.95%), C. krusei (6.15%), and C. glabrata (5.59%). The susceptibility of non-aspergillus fungi for amphotericin B was 100.0%. The susceptibility rates of 5-FC and voriconazole were 72.73% and 81.82%, respectively, for C. krusei, 98.43% and 100% for C. albicans, and 100% for both drugs for C. glabrata, C. parapsilosis, and C. tropicalis. The susceptibility rates of fluconazole and itraconazole were 0% and 54.55%, respectively, for C. krusei, 20% and 20% for C. glabrata, and 57.14% and 57.14% for C. tropicalis. The resistance rate of C. tropicalis for fluconazole and itraconazole were both 41.43%.
Conclusions: Patients in the respiratory department, ICU, and hepatology department presented high rates of invasive fungal infections and should include special attention during clinical treatment. The respiratory tract, urinary tract, and gastrointestinal tract were the susceptible systems. Candida, especially C.albicans, was the main pathogen. From the perspective of drug sensitivity, amphotericin B should be given priority in treating the non-aspergillus fungi infection in patients with systemic internal diseases, while the susceptibility of invasive fungal strains to azoles was variant. These data might provide clinical evidence for the prevention and treatment of invasive fungal infection in patients with systemic internal diseases.