RESUMO
Candida tropicalis is a common human pathogenic yeast, and its molecular typing is important for studying the population structure and epidemiology of this opportunistic yeast, such as epidemic genotype, population dynamics, nosocomial infection, and drug resistance surveillance. In this study, the antifungal susceptibility test and multilocus sequence typing (MLST) analysis were carried out on C. tropicalis from central China. Among 64 urogenital isolates, 45 diploid sequence types (DST) were found, of which 20 DSTs (44.4%) were new to the central database. The goeBURST analysis showed that CC1 (clonal complex) was the only azole-resistant (100%, 10/10) cluster in Wuhan, which was composed of DST546, DST225, DST376, and DST506, and most of the strains (90%, 9/10) were isolated from the urinary tract. Potential nosocomial infections were mainly caused by CC1 strains. The azole resistance rate of urinary isolates (50.0%, 21/42) was higher than that of vaginal isolates (27.3%, 6/22). The genotype diversity and novelty of vaginal isolates were higher than those of urinary isolates. C. tropicalis population in Wuhan was genetically diverse and divergent from that seen in other countries. In this study, there were significant differences in genotype and azole susceptibility between urine and vaginal strains. The azole-resistant cluster (CC1) found in urine is of great significance for the clinical treatment and prevention of nosocomial infection. The newly discovered DSTs will contribute to further study the similarity, genetic relationship, and molecular epidemiology of C. tropicalis worldwide.
Assuntos
Azóis/uso terapêutico , Candida tropicalis/isolamento & purificação , Candidíase/epidemiologia , Farmacorresistência Fúngica/genética , Infecções do Sistema Genital/epidemiologia , Infecções Urinárias/epidemiologia , Antifúngicos/uso terapêutico , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/genética , Candidíase/tratamento farmacológico , Candidíase/microbiologia , China/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Técnicas de Tipagem Micológica , Infecções do Sistema Genital/tratamento farmacológico , Infecções do Sistema Genital/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologiaRESUMO
Meta-analyses that ignore the full programme of clinical trials may lead to a misleading interpretation. We did a comprehensive meta-analysis to explore the efficacy of sulbactam for the treatment of Acinetobacter baumannii complex infection. We searched electronic databases, including Pubmed and Embase up to April 24, 2016, to identify relevant published trials. Clinical trial registries were likewise searched to identify completed unpublished studies. Primary outcomes of interest were the clinical and microbiological efficacy and in-hospital mortality. Effect model was based on heterogeneity across studies. Altogether 12 observational trials, comprising about 1500 patients, were included. Compared with control group, the clinical response (OR 1.16, 95% CI 0.77-1.75), bacteriological response (OR 1.71, 95% CI 0.89-3.29) and in-hospital mortality (OR 0.76, 95% CI 0.57-1.01) of sulbactam-based therapy group achieved similar therapeutic in A. baumannii complex infection. Subgroup analysis showed the clinical response (OR 1.66, 95% CI 1.11-2.48) of A. baumannii complex infection favored high-dose sulbactam group. In conclusion, our findings suggested that the overall therapy effect of sulbactam was no more superior than alternative therapeutics. However, when taking consideration of the dose factor, we found that high dosage regimen of sulbactam showed an obvious advantage in the treatment of A. baumannii complex infection.