耳念珠菌感染的研究进展

doi:10.19871/j.cnki.xfcrbzz.2025.03.014

摘要/Abstract

摘要： 耳念珠菌（Candida auris）是一种新兴酵母真菌,呈椭圆形或卵圆形,大小为（2.0~3.0）μm×（2.5~5.0）μm,可单独及聚集性生长。耳念珠菌于2009年首次在1例日本患者的外耳道分泌物中被分离、鉴定,随后在全球40多个国家快速传播。该菌可在人体皮肤上定植,当机体抵抗力低下时引起系统性深部真菌病,而耳念珠菌感染常见于重症医疗环境。耳念珠菌的典型特征具有多重耐药性,治疗药物有限,因此,耳念珠菌引起的侵袭性感染病死率可高达30%~60%,对免疫缺陷人群的健康安全构成了巨大威胁。为了提高我国医务人员对耳念珠菌的认知,本文从耳念珠菌感染的病原学、全球流行情况、临床特征、诊断、治疗及其预防与控制等方面进行全面综述,以期为未来的临床救治及科研工作提供直接或间接的理论和实践参考。

关键词: 耳念珠菌, 病原学, 感染, 诊断, 治疗, 预防与控制

Abstract: Candida auris is an emerging yeast fungus, oval or ovoid in shape, with a size of approximately (2.0-3.0)μm × (2.5-5.0)μm, capable of growing singly or in clusters. It was first isolated and identified in the ear canal secretions of a patient from Japan in 2009, and has since rapidly spread to over 40 countries worldwide. This fungus can colonize human skin and cause systemic deep fungal infections when the host's immunity is low, with infections commonly occurring in critical medical environments. A typical characteristic of Candida auris is its multidrug resistance, leading to limited treatment options. Thereby, its invasive infections can result in mortality rates as high as 30%-60%, posing a significant threat to the health and safety of immunocompromised individuals. In order to enhance the awareness of healthcare professionals in China about this fungus, this article provides a comprehensive review of Candida auris, covering itsetiology, global epidemiology, clinical features, diagnosis, treatment, prevention, and control, aiming to offer direct or indirect theoretical and practical references for future clinical treatment and research efforts.

Key words: Candida auris, Etiology, Infection, Diagnosis, Treatment, Prevention and control

中图分类号:

R519.3

李秋萍, 姚伟明, 冯世艳, 林元龙, 王福祥. 耳念珠菌感染的研究进展[J]. 新发传染病电子杂志, 2025, 10(3): 78-83.

Li Qiuping, Yao Weiming, Feng Shiyan, Lin Yuanlong, Wang Fuxiang. Research progress on Candida auris infection: a systematic review[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(3): 78-83.

参考文献

[1] SATOH K,MAKIMURA K, HASUMI Y, et al.Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a japanese hospital[J]. Microbiol Immunol,2009, 53(1): 41-44.
[2] DE CÁSSIA ORLANDISARDIJ, SILVA DR, SOARES MENDES-GIANNINI MJ, et al. Candida auris: epidemiology, risk factors, virulence, resistance, and therapeutic options[J]. Microb Pathog, 2018, 125: 116-121.
[3] RHODES J, ABDOLRASOULI A, FARRER RA, et al.Genomic epidemiology of the UK outbreak of the emerging human fungal pathogen candida auris[J]. Emerg Microbes Infect, 2018, 7(1): 43.
[4] BING J, DU H, GUO P, et al.Candida auris-associated hospitalizations and outbreaks, china, 2018-2023[J]. Emerg Microbes Infect, 2024, 13(1): 2302843.
[5] U.S.CENTERS FOR DISEASE CONTROL AND PREVENTION. Tracking C.auris[EB/OL].[2024-12-15]. https://www.cdc.gov/candida-auris/tracking-c-auris/index.html.
[6] 廖万清. 医学真菌研究的前沿及热点[J/CD].新发传染病电子杂志, 2018, 3(3):129-133.
[7] LEE WG, SHIN JH, UH Y, et al.First three reported cases of nosocomial fungemia caused by Candida auris[J]. J Clin Microbiol, 2011, 49(9): 3139-3142.
[8] KIM MN, SHIN JH, SUNG H, et al.Candida haemulonii and closely related species at 5 university hospitals in Korea: identification, antifungal susceptibility, and clinical features[J]. Clin Infect Dis, 2009, 48(6): e57-61.
[9] PFALLER MA, DIEKEMA DJ, TURNIDGE JD, et al.Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997-2016[J]. Open Forum Infect Dis, 2019, 6(Suppl 1): S79-S94.
[10] THE LANCET MICROBE.Candida auris: new clade, same challenges[J]. Lancet Microbe, 2024, 5(9): 100977.
[11] MISSERI G, IPPOLITO M, CORTEGIANI A.Global warming “heating up”the ICU through Candida auris infections: the climate changes theory[J]. Crit Care, 2019, 23(1): 416.
[12] SUPHAVILAI C, KO KKK, LIM KM, et al.Detection and characterisation of a sixth Candida auris clade in Singapore: a genomic and phenotypic study[J]. Lancet Microbe, 2024, 5(9): 100878.
[13] LOCKHART SR, ETIENNE KA, ALLABHANENI S, et al.Simultaneous emergence of multidrug-resistant candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses[J]. Clin Infect Dis, 2017, 64(2): 134-140.
[14] MUÑOZ JF, GADE L, CHOW NA, et al. Genomic insights into multidrug-resistance, mating and virulence in Candida auris and related emerging species[J]. Nat Commun, 2018, 9(1): 5346.
[15] BORMAN AM, SZEKELY A, JOHNSON EM.Isolates of the emerging pathogen Candida auris present in the UK have several geographic origins[J]. Med Mycol, 2017, 55(5): 563-567.
[16] KIM JS, CHA H, BAHN YS.Comprehensive overview of candida auris: an emerging multidrug-resistant fungal pathogen[J]. J Microbiol Biotechnol, 2024, 34(7): 1365-1375.
[17] LIONAKIS MS, CHOWDHARY A.Candida auris Infections[J]. N Engl J Med, 2024, 391(20): 1924-1935.
[18] BING J, GUAN Z, ZHENG T, et al.Clinical isolates of candida auris with enhanced adherence and biofilm formation due to genomic amplification of ALS4[J]. PLoS Pathog, 2023, 19(3): e1011239.
[19] SHARMA SM, SHARMA R, CHANDRATEYA P.Intensification of invasive fungal infections and exploration of effective antifungal drug delivery formulations: a detailed review[J]. Infect Disord Drug Targets, 2024.
[20] BROWN GD, DENNING DW, GOW NAR, et al. Hidden Killers: Human Fungal Infections[J]. Sci Transl Med, 2012, 4(165): 165rv13-165rv13.
[21] PALLOTTA F, VIALE P, BARCHIESI F.Candida auris: the new fungal threat[J]. Infez Med, 2023, 31(3): 323-328.
[22] SANTANA DJ, ANKU JAE, ZHAO G, et al.A Candida auris-specific adhesin, Scf1, governs surface association, colonization, and virulence[J]. Science, 2023, 381(6665): 1461-1467.
[23] HERNANDO-ORTIZ A, MATEO E, PEREZ-RODRIGUEZ A, et al.Virulence of candida auris from different clinical origins in caenorhabditis elegans and galleria mellonella host models[J]. Virulence, 2021, 12(1): 1063-1075.
[24] HORTON MV, HOLT AM, NETT JE.Mechanisms of pathogenicity for the emerging fungus Candida auris[J]. PLoS Pathog, 2023, 19(12): e1011843.
[25] WANG Q, CHENG S, WANG Y, et al.Global characteristics and trends in research on candida auris[J]. Front Microbiol, 2023, 14:1287003.
[26] LARKIN E, HAGER C, CHANDRA J, et al.The emerging pathogen candida auris: growth phenotype, virulence factors, activity of antifungals, and effect of SCY-078, a novel glucan synthesis inhibitor, on growth morphology and biofilm formation[J]. Antimicrob Agents Chemother, 2017, 61(5): e02396-16.
[27] KEAN R, MCKLOUD E, TOWNSEND EM, et al.The comparative efficacy of antiseptics against Candida auris biofilms[J]. Int J Antimicrob Agents, 2018, 52(5): 673-677.
[28] KRIEGL L, EGGER M, BOYER J, et al.New treatment options for critically important WHO fungal priority pathogens[J]. Clin Microbiol Infect, 2024.
[29] CHAKRABARTI A, SOOD P, RUDRAMURTHY SM, et al.Incidence, characteristics and outcome of ICU-acquired candidemia in India[J]. Intensive Care Med, 2015, 41(2): 285-295.
[30] EYRE DW, SHEPPARD AE, MADDER H, et al.A candida auris outbreak and its control in an intensive care setting[J]. N Engl J Med, 2018, 379(14): 1322-1331.
[31] OSEI SEKYERE J.Candida auris: A systematic review and meta-analysis of current updates on an emerging multidrug-resistant pathogen[J]. Microbiologyopen, 2019, 8(8): e00901.
[32] PLACHOURAS D, LÖTSCH F, KOHLENBERG A, et al. Candida auris: epidemiological situation, laboratory capacity and preparedness in the European Union and European Economic Area*, January 2018 to May 2019[J]. Euro Surveill, 2020, 25(12): 2000240.
[33] BING J, DU H, GUO P, et al.Candida auris-associated hospitalizations and outbreaks, China, 2018-2023[J]. Emerg Microbes Infect, 2024, 13(1): 2302843.
[34] MULET BAYONA JV, SALVADOR GARCÍA C, TORMO PALOP N, et al. Evaluation of a novel chromogenic medium for Candida spp. identification and comparison with CHROMagarTM Candida for the detection of Candida auris in surveillance samples[J]. Diagn Microbiol Infect Dis, 2020, 98(4): 115168.
[35] GIRARD V, MAILLER S, CHETRY M, et al.Identification and typing of the emerging pathogen Candida auris by matrix-assisted laser desorption ionisation time of flight mass spectrometry[J]. Mycoses, 2016, 59(8):535-538.
[36] 邹玉, 陈宗耀, 鄂建飞, 等. 耳念珠菌实验室鉴定方法的研究进展[J]. 中国真菌学杂志, 2022, 17(5): 414-420, 424.
[37] BHATTACHARYA S, HOLOWKA T, ORNER EP, et al.Gene Duplication Associated with Increased Fluconazole Tolerance in Candida auris cells of Advanced Generational Age[J]. Sci Rep, 2019, 9(1): 5052.
[38] CHOWDHARY A, PRAKASH A, SHARMA C, et al.A multicentre study of antifungal susceptibility patterns among 350 candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance[J]. J Antimicrob Chemother, 2018, 73(4): 891-899.
[39] 中国成人念珠菌病诊断与治疗专家共识组. 中国成人念珠菌病诊断与治疗专家共识[J]. 中华传染病杂志, 2020, 38(1): 29-43.
[40] BORGIO JF, ALHUJAILY R, ALFARAJ AS, et al.Genome-guided identification of surfactin-producing bacillus halotolerans AQ11M9 with anti-candida auris potential[J]. Int J Mol Sci, 2024, 25(19): 10408.
[41] ARENDRUP MC, JØRGENSEN KM, HARE RK, et al. In Vitro Activity of Ibrexafungerp (SCY-078) against Candida auris Isolates as Determined by EUCAST Methodology and Comparison with Activity against C. albicans and C. glabrata and with the Activities of Six Comparator Agents[J]. Antimicrob Agents Chemother, 2020, 64(3): e02136-19.
[42] TETZ G, COLLINS M, VIKINA D, et al.In vitro activity of a novel antifungal compound, MYC-053, against clinically significant antifungal-resistant strains of candida glabrata, candida auris, cryptococcus neoformans, and pneumocystis spp[J]. Antimicrob Agents Chemother, 2019, 63(4): e01975-18.
[43] PIEDRAHITA CT, CADNUM JL, JENCSON AL, et al.Environmental surfaces in healthcare facilities are a potential source for transmission of candida auris and other candida species[J]. Infect Control Hosp Epidemiol, 2017, 38(9): 1107-1109.
[44] FORSBERG K, WOODWORTH K, WALTERS M, et al.Candida auris : The recent emergence of a multidrug-resistant fungal pathogen[J]. Med Mycol, 2019, 57(1): 1-12.
[45] 黄劲华, 孔旭辉, 丁滢, 等. 葡萄糖酸氯己定擦浴预防ICU患者多重耐药菌感染[J]. 中国感染控制杂志, 2018, 17(3): 252-255.