南方医科大学学报

南方医科大学学报 ›› 2026, Vol. 46 ›› Issue (7): 1576-1584.doi: 10.12122/j.issn.1673-4254.2026.07.11

• • 上一篇    

MALDI-TOF MS 可快速检测热带念珠菌的氟康唑耐药性

侯杰1,2(), 陈维琳2(), 彭亮2, 乔甫3, 康梅2(), 马莹2()   

  1. 1.四川大学华西天府医院实验医学科，四川 成都 610213；四川大学华西医院2. 实验医学科//临床检验医学研究中心//四川省医学检验临床医学研究中心
    3.感染管理部，四川 成都 610041
  • 收稿日期:2025-11-07 出版日期:2026-07-20 发布日期:2026-07-20
  • 通讯作者: 康梅,马莹 E-mail:microbe_houjie@hotmail.com;wl1335058287@163.com;kangmei@sina.com;majiying72@hotmail.com
  • 作者简介:侯 杰，硕士，E-mail: microbe_houjie@hotmail.com
    陈维琳，硕士，E-mail: wl1335058287@163.com
    第一联系人：侯 杰、陈维琳共同为第一作者
  • 基金资助:
    新发突发与重大传染病防控国家科技重大专项(2025ZD01902203)

Rapid detection of fluconazole resistance in Candida tropicalis using MALDI-TOF mass spectrometry

Jie HOU1,2(), Weilin CHEN2(), Liang PENG2, Fu QIAO3, Mei KANG2(), Ying MA2()   

  1. 1.Department of Laboratory Medicine, West China Tianfu Hospital of Sichuan University, Chengdu 610213, China
    2.Department of Laboratory Medicine, Clinical Laboratory Medicine Research Center, Sichuan Clinical Research Center for Laboratory Medicine
    3.Department of Infection Control, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2025-11-07 Online:2026-07-20 Published:2026-07-20
  • Contact: Mei KANG, Ying MA E-mail:microbe_houjie@hotmail.com;wl1335058287@163.com;kangmei@sina.com;majiying72@hotmail.com

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摘要：

目的 评估基于基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）的抗真菌药物敏感性试验（MS-AFST）快速检测热带念珠菌氟康唑耐药性的临床应用潜能。 方法 回顾性分析2018~2023年四川大学华西医院血流感染热带念珠菌的检出情况，并经念珠菌显色培养与MALDI-TOF MS行菌种鉴定。抗真菌药物敏感性试验以 CLSI 微量肉汤稀释法（BMD）为参考标准，对比评估 Sensititre YeastOne 显色药敏试验、优化前处理后基于最小谱图改变浓度（MPCC）的 MS-AFST 法检测氟康唑耐药性的一致性。 结果 本研究纳入的41分离株均为热带念珠菌，其唑类耐药率和非野生型菌株占比在36.59%~68.29%，且唑类高度交叉耐药。Sensititre YeastOne与CLSI BMD的分类一致性和基本一致性均为100%，二者最小抑菌浓度高度相关。基于MPCC的MS-AFST可以3 h左右快速检测热带念珠菌氟康唑耐药表型，与CLSI BMD参考方法和Sensititre YeastOne的分类一致性均为92.68%，基本一致性均为90.24%，极重大误差2株，小误差1株。 结论 基于 MPCC 的 MS-AFST 可快速检测热带念珠菌氟康唑耐药性，且与参考方法一致性较好，但仍存在分类错误，需进一步优化方法并探究其机制。

关键词: MALDI-TOF MS, 抗真菌药物耐药性, 抗真菌药物敏感性试验, 热带念珠菌, 氟康唑, 唑类

Abstract:

Objective To evaluate the efficacy of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based antifungal susceptibility testing (MS-AFST) for rapid detection of fluconazole resistance in Candida tropicalis. Methods C. tropicalis isolates from patients with bloodstream infections at West China Hospital of Sichuan University (2018-2023) were collected and identified by chromogenic culture and MALDI-TOF MS. Using Clinical and Laboratory Standards Institute broth microdilution (BMD) method as the reference standard, we compared the performance of the Sensititre YeastOne chromogenic antifungal susceptibility testing and optimized MS-AFST based on the minimum profile change concentration (MPCC). Results All the 41 isolates were confirmed as C. tropicalis, which showed an azole resistance rate of 36.59% and a proportion of non-wild-type strain of 68.29% with high cross-resistance to azoles. The categorical agreement (CA) and essential agreement (EA) between Sensititre YeastOne and CLSI BMD were both 100%, and their minimum inhibitory concentrations were highly correlated. The MPCC-based MS-AFST enabled rapid detection of fluconazole-resistant phenotype of C. tropicalis within approximately 3 h, demonstrating a CA of 92.68% and an EA of 90.24% both in comparison with the CLSI BMD reference method and Sensititre YeastOne; very major error\discrepancy occurred in two strains, and minor error\discrepancy occurred in one strain. Conclusion MPCC-based MS-AFST enables rapid, reliable detection of fluconazole resistance in C. tropicalis with good agreement with the reference methods. However, classification errors remain, which should be improved by further technical optimization of this method and exploration of the underlying molecular mechanisms.

Key words: matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, antifungal resistance, antifungal susceptibility testing, Candida tropicalis, fluconazole, azoles