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侵袭性念珠菌病(invasive candidiasis)是院内血液感染的第四大原因[1]。由于各类疾病导致的免疫力低下病人增多,光滑念珠菌(Candida glabrata)的感染率逐年递增,引起败血症的数量也随之增加。除白念珠菌外,光滑念珠菌已成为部分国家和地区侵袭性感染中第二常见的念珠菌种类[2]。光滑念珠菌是一种条件致病菌,它广泛存在于自然界,也在人体皮肤黏膜、消化道寄生。当人体免疫功能降低或皮肤黏膜环境发生改变时,光滑念珠菌即可大量繁殖,引起深部脏器感染。与其他念珠菌相比,光滑念珠菌对于抗真菌药物显著耐受[3],它可以在抗真菌治疗过程中迅速产生耐药性,最终导致治疗失败[4-5]。我国侵袭性真菌耐药监测网(CHIF-NET)2020年统计结果显示,临床常用抗真菌药物氟康唑和伏立康唑对光滑念珠菌的最低抑菌浓度(MIC90)分别32 μg/ml和1 μg/ml。目前治疗光滑念珠菌的药物主要包括广谱三唑类、棘白菌素类以及多烯类抗真菌药。本文对光滑念珠菌的耐药机制进行综述。
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