Candida infections are among the most common fungal diseases worldwide and are associated with notable morbidity and mortality, particularly in immunocompromised and critically ill patients. Moreover, the emergence and spread of antifungal resistance pose an increasing threat to global public health. Therefore, evidence-based recommendations are urgently needed to guide the surveillance and control of Candida infections. A multidisciplinary guidance development group comprising experts of infectious diseases, clinical microbiology, pharmacology, infection control, and guideline methodology jointly developed the present clinical practice guidance. The process followed internationally recognized grading of recommendations, assessment, development and evaluation (GRADE) framework. Clinical questions were formulated based on priority issues or areas of uncertainty in current practice, and corresponding recommendations were developed after systematic review and synthesis of the best available evidence. The strength of recommendations was classified as strong or conditional (weak), and the certainty of evidence was graded from high to low. The guidance provides recommendations on diagnostic strategies, antifungal therapy, and infection prevention and control measures for Candida infections, integrating both global evidence and national clinical experience. The target users include clinicians, microbiologists, infection control practitioners, and policymakers involved in the management of fungal diseases. The guidance aims to support optimized clinical decision-making, improve antifungal stewardship, and strengthen infection control strategies to address the growing challenge posed by Candida infections.

BACKGROUND:Neonatal necrotizing enterocolitis (NEC) is linked to gut microbiota dysbiosis and inflammation. Bifidobacterium-mediated tryptophan metabolites, including indole-3-lactic acid (ILA), may exert anti-inflammatory effects via the aryl hydrocarbon receptor (AhR) pathway. This study investigated the protective effects and mechanisms of Bifidobacterium BB-12 in NEC. METHODS:Neonatal rats were assigned to a control, NEC, and Bifidobacterium-treated NEC groups. Clinical symptoms, survival, serum cytokines, intestinal pathology, microbiota structure (16S rRNA sequencing), and AhR/CYP1A1 expression (quantitative reverse transcription polymerase chain reaction, western blotting) were evaluated. Colon metabolomics and in vitro lipopolysaccharide (LPS)-induced intestinal epithelial cell assays with AhR knockdown were performed to assess the role of ILA. RESULTS:Bifidobacterium markedly alleviated symptoms, reduced intestinal damage, increased survival, and suppressed inflammatory factors. It restored gut microbiota diversity by increasing beneficial taxa (Bacteroidetes, Actinobacteria, Bifidobacterium), and decreasing pathogenic bacteria (Proteobacteria, Shigella-Escherichia). AhR/CYP1A1 expression was upregulated and negatively correlated with tissue damage. Metabolomics revealed elevated levels of ILA, indole-3-aldehyde, and 3-hydroxyanthranilic acid. In vitro, ILA inhibited LPS-induced inflammation and upregulated AhR/CYP1A1, while AhR knockdown largely abolished these effects. CONCLUSION:Bifidobacterium BB-12 protects against NEC by reshaping the gut microbiota, activating the AhR-CYP1A1 pathway, and regulating tryptophan metabolites, with ILA partially mediating its anti-inflammatory effects. IMPACT:Neonatal necrotizing enterocolitis is a severe inflammatory bowel disease in premature infants with limited treatment options, highlighting the need for new preventive and therapeutic strategies. Bifidobacterium is an effective probiotic, but its molecular mechanisms in NEC through host metabolic-immune interactions remain unclear. This study strongly suggest that in a neonatal rat NEC model, Bifidobacterium alleviates intestinal inflammation and tissue damage by reshaping the gut microbiota, elevating tryptophan metabolites like ILA, and activating the AhR-CYP1A1 signaling pathway. The findings provide a framework for understanding probiotic-mediated gut protection and potential targets for interventions using microbial metabolites or AhR agonists.

Invasive pulmonary fungal diseases (IPFD) continue to posing an increasing clinical and public health burden on immunocompromised populations. In many Asian settings, the diagnosis of IPFD faces substantial challenges driven by the high prevalence of comorbidities, including poorly controlled diabetes, tuberculosis (TB), and human immunodeficiency virus (HIV) infection, considerable heterogeneity in local pathogens, and disparities in access to diagnostic resources. To address these unmet needs, experts from 18 countries collaboratively developed this consensus, which provides a diagnostic algorithm tailored to high-burden Asian settings based on existing international and regional guidelines. When clinical manifestations are atypical or diagnostic clues are limited, the algorithm prioritizes evaluation for common and regionally prevalent IPFD, followed by stepwise expansion to other potential fungal pathogens. In addition, this consensus outlines the regional accessibility of different diagnostic modalities across Asia. This consensus focuses exclusively on optimization of the diagnostic algorithm and does not provide specific recommendations regarding antifungal therapy. Notably, improved diagnosis of IPFD through this algorithm may contribute to better patient outcomes and strengthened public health strategies in high-burden regions.

OBJECTIVES:To investigate the epidemiology and molecular typing of 307 clinical Wickerhamomyces anomalus isolates collected in China. METHODS:A total of 307 W. anomalus isolates were collected from CHIF-NET, a surveillance network with nationwide coverage, from 2009 to 2021. Antifungal susceptibility of all W. anomalus isolates were tested by broth microdilution according to CLSI methods. Genotyping of all isolates was performed using a panel of polymorphic microsatellite markers. RESULTS:The number of W. anomalus isolates was highest in Northeast China, with 121 strains, accounting for 4.6% of the total Candida spp. isolates in the region. Newborns emerged as the primary community of infection, with 84 isolates (12.7% of all Candida spp. in the newborn group). Most W. anomalus isolates were recovered from blood samples (249 isolates). The isolates were found to exhibit notable ratios of non-wild type to fluconazole and voriconazole (48.5% and 34.5%). A total of 118 microsatellite-based types were identified among a set of 309 isolates that included the 307 clinical isolates along with reference strains ATCC 8168 and CICC 32553. This analysis revealed potential nosocomial outbreaks. CONCLUSIONS:Our research is the largest investigation of W. anomalus drug susceptibility thus far, providing foundational data that could contribute to future establishment of resistance breakpoints and enhancing epidemiological surveillance capabilities. Our study suggests the importance of nosocomial surveillance and drug resistance management for W. anomalus.

Invasive aspergillosis (IA), caused by Aspergillus, requires prompt diagnosis and treatment. Here, the efficacy of a chemiluminescence immunoassay (CLIA) for detecting Aspergillus galactomannan (GM) antigen in serum and bronchoalveolar lavage fluid (BALF) was evaluated. Overall, 265 patients with suspected IA were enrolled between March and May 2023 and were stratified into IA (n = 48) and non-IA (n = 217) cohorts. A total of 265 samples (208 serum, 57 BALF) were analyzed with GM-CLIA. The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Diagnostic performance was assessed with receiver operating characteristic (ROC) curves. GM-CLIA demonstrated sensitivity/specificity values of 88.00%/93.44% in serum and 91.30%/76.47% in BALF. The sensitivity for all samples was 89.58% with a specificity of 90.78%, while PPV and NPV were 69.25% and 97.52%, respectively. The AUC (area under the ROC curve) was 0.93 (95% confidence interval [CI], 0.89–0.97, P < .001), with an optimal cutoff value of 0.70 ng/ml. The GM-CLIA enables automated detection of individual samples (serum/BALF) on a fully integrated chemiluminescence platform. This system delivers high specificity (90.78%), sensitivity (89.58%), enabling prompt diagnosis and treatment of IA.

With an increase in the number of patients who are immunosuppressed or immunocompromised there has been an increase in invasive fungal infection in the past few decades with its associated high morbidity and mortality, ranging from 60% to 90%. The role of early and accurate diagnosis in the aggressive containment of the fungal infection at the initial stages becomes crucial, preventing the development of a life-threatening situation. Conventional fungal identification depends on microscopic analysis and microorganism medium growth. Serological testing represents a quicker way of detecting the causal fungi, aiding in the diagnostic decision-making process. The advantage of performing serology-based tests is the rapid results obtained, unlike culture methods, and the non-invasive nature of the sample (i.e. blood, urine, sputum, etc.) while acting as a potential prognostic marker, for example, (1,3)-ß-D-glucan (BDG assay) and galactomannan(GM assay). Recently, a novel chemiluminescent immunoassay (CLIA) for BDG and GM from Dynamiker Biotechnology (Tianjin) Co., Ltd. was released as a screening test of invasive aspergillosis (IA). It is a fully automated assay with high throughput and short detection time. Here, we explored diagnostic value of combined detection of BDG-CLIA and GM-CLIA for IA. A total of 114 patients were admitted from March 2023 to July 2023 were enrolled. According to 2019 EORTC/MSG definitions of invasive aspergillosis, they were divided into IA group (67 cases) and non-IA group (47 cases). The samples were tested in parallel using the Dynamiker BDG-CLIA and GM-CLIA. The sensitivity and specificity of GM-CLIA method were 86.57% and 82.98%, and that of G-CLIA method were 68.66% and 70.21%, respectively. Compared with BDG-CLIA alone or GM-CLIA alone, sensitivity of combined diagnosis for IA was significantly improved (92.53%, 95% CI: 82.74-97.22, P<0.05). The combined deteclion of BDG-CLIA and GM-CLIA can effectively improve diagnostic sensitivity of IA patients, and can be used as an auxiliary diagnosis for invasive pulmonary fungal infection.

Invasive aspergillosis (IA) has been a well- known infectious complication in patients with severe immunosuppression, associated with high morbidity and mortality. Although IA was reported to contribute to increased mortality in the ICU population the diagnosis in not straightforward. The novel MycoMDx Aspergillus PCR assay with melting curve analysis produced by Dynamiker Biotechnology (Tianjin) Co., Ltd was a rapid, reliable and sensitive clinical diagnostic technique. The study evaluated the Multiplex PCR Assay for the diagnosis of IA. A total of 611 BALF samples with proven IA (n =114), probable IA (n = 177) and control samples (not fulfilling 2019 EORTC/MSG guideline IA criteria, n=320) were included. All the samples were tested using the MycoMDx Aspergillus PCR Assay Kit. The sensitivity and specificity of MycoMDx Aspergillus PCR were 90.03% (262/291) and 95.63% (306/320), respectively. The concordance of detection results between Dynamiker MycoMDx Aspergillus PCR and Sanger sequencing assays was high. The results of Dynamiker MycoMDx PCR and Sanger sequencing for the identification of different Aspergillus species showed that the total percent agreement of the two methods for Aflatus, Aspergillus Niger and Aspergillus terreus reached 100%, and the total percent agreement for Aspergillus fumigus was 99.37%. The Dynamiker MycoMDx Aspergillus PCR is a useful tool for the rapid identification of Aspergillus species and might be useful as an early diagnostic tool to detect an invasive aspergillosis.

耳念珠菌是一种近年来新出现的致病性真菌,可引起严重的侵袭性感染,病死率高.通过对已报道的265例患者资料分析,发现耳念珠菌感染患者常见男性,分离株主要来自血液、尿液和耳道、导管等.耳念珠菌感染患者往往伴有基础疾病,以糖尿病、高血压、肺部疾病为主.危险因素包括既往使用过广谱抗生素或抗真菌药物、内置导管、侵入性医疗操作等.该文对全球耳念珠菌感染以及新冠病毒肺炎合并耳念珠菌感染的情况进行报道,对全面了解耳念珠菌临床特征、诊断及治疗具有重要意义.

Candida haemulonii, a relative of C. auris, frequently shows antifungal resistance and is transmissible. However, molecular tools for genotyping and investigating outbreaks are not yet established. We performed genome-based population analysis on 94 C. haemulonii strains, including 58 isolates from China and 36 other published strains. Phylogenetic analysis revealed that C. haemulonii can be divided into 4 clades. Clade 1 comprised strains from China and other global strains; clades 2–4 contained only isolates from China, were more recently evolved, and showed higher antifungal resistance. Four regional epidemic clusters (A, B, C, and D) were identified in China, each comprising ≥5 cases (largest intracluster pairwise single-nucleotide polymorphism differences <50 bp). Cluster A was identified in 2 hospitals located in the same city, suggesting potential intracity transmissions. Cluster D was resistant to 3 classes of antifungals. The emergence of more resistant phylogenetic clades and regional dissemination of antifungal-resistant C. haemulonii warrants further monitoring.

Candida albicans remains the most common species causing invasive candidiasis. In this study, we present the population structure of 551 global C. albicans strains. Of these, the antifungal susceptibilities of 370 strains were tested. Specifically, 66.6% of the azole-nonsusceptible (NS)/non-wild-type (NWT) strains that were tested belonged to Clade 1. A phylogenetic analysis, a principal components analysis, the population structure, and a loss of heterozygosity events revealed two nested subclades in Clade 1, namely, Clade 1-R and Clade 1-R-α, that exhibited higher azole-NS/NWT rates (75.0% and 100%, respectively). In contrast, 6.4% (21/326) of the non-Clade 1-R isolates were NS/NWT to at least 1 of 4 azoles. Notably, all of the Clade 1-R-α isolates were pan-azole-NS/NWT that carried unique A114S and Y257H double substitutions in Erg11p and had the overexpression of ABC-type efflux pumps introduced by the substitution A736V in transcript factor Tac1p. It is worth noting that the Clade 1-R and Clade 1-R-α isolates were from different cities that are distributed over a large geographic span. Our study demonstrated the presence of specific phylogenetic subclades that are associated with antifungal resistance among C. albicans Clade 1, which calls for public attention on the monitoring of the future spread of these clones. IMPORTANCE Invasive candidiasis is the most common human fungal disease among hospitalized patients, and Candida albicans is the predominant pathogen. Considering the large number of infected cases and the limited alternative therapies, the azole-resistance of C. albicans brings a huge clinical threat. Here, our study suggested that antifungal resistance in C. albicans could also be associated with phylogenetic lineages. Specifically, it was revealed that more than half of the azole-resistant C. albicans strains belonged to the same clade. Furthermore, two nested subclades of the clade exhibited extremely high azole-resistance. It is worth noting that the isolates of two subclades were from different cities that are distributed over a large geographic span in China. This indicates that the azole-resistant C. albicans subclades may develop into serious public health concerns.

隐球菌病通常被视为一种机会性感染,既可发生于免疫功能正常者,也可发生在艾滋病和其他免疫功能低下人群,临床常见肺隐球菌病和隐球菌性脑膜炎.血液、脑脊液样本的隐球菌荚膜多糖抗原检测可作为隐球菌感染的确诊依据,常用检测方法包括侧流免疫层析法、乳胶凝集法和酶联免疫分析法.该文总结引起隐球菌荚膜多糖抗原不同检测方法结果假阳性、假阴性的干扰因素,包括宿主基础疾病、交叉反应、药物因素、操作因素、样本因素等,旨在帮助临床医生正确评估其检测结果,指导临床实践.

目的 通过对中国侵袭性真菌监测网(CHIF-NET)2013年中国48家综合医院收集的1562株酵母菌进行流行病学分布及唑类耐药性分析,为临床侵袭性酵母菌的唑类用药提供数据基础.方法 收集2013年中国侵袭性真菌监测网48家医院共1562株酵母菌菌株及其原始信息,采用基质辅助激光解析电离飞行时间质谱(MALDI-TO MS,法国生物梅里埃公司)结合核糖体DNA测序明确菌种鉴定;根据美国临床实验室标准化协会(CLSI) M44-A2纸片扩散法检测菌株对氟康唑及伏立康唑的敏感性.结果 本研究共分离出酵母菌1562株,其中白念珠菌分离率最高(38.4％),其次为近平滑念珠菌复合体(18.4％)、热带念珠菌(16.4％)、光滑念珠菌复合体(9.4％)及其他少见菌种(＜6.4％);患者性别中男性占比(60.7％)高于女性(38.9％);患者年龄中,65岁以上年龄段患者最多(34.2％),其次为50～65岁(30.6％)、15～49岁(29.9％)和0～14岁患者(＜1.9％);标本来源中以血液标本(46.4％)为主,其次为腹水(10.2％)、导管(9.2％)及引流液(8.5％)、分泌物(5.2％),其他标本类型均较少(＜4.7％).住院患者分离率(93％)显著高于门急诊患者(7％);科室类型中以外科患者(33.8％)为主,其次为重症监护病房(ICU)患者(27.5％)、内科患者(20.5％)及其他病房(＜18.2％);药敏结果显示,白念珠菌及近平滑念珠菌复合体对对氟康唑及伏立康唑敏感性均较高(＞94％),热带念珠菌对氟康唑及伏立康交叉耐药率最高(21.9％),光滑念珠菌复合体交叉耐药率次之(15％),其次为季也蒙念珠菌(8.1％)和菌膜念珠菌(4.3％).结论 应持续加强中国地区侵袭性酵母菌监测,在使用抗菌药物过程中,合理控制其用量,防止耐药率的上升.

Since the initial emergence of coronavirus disease 2019 (COVID-19) in Wuhan, Hubei province, China, a rapid spread of the disease occurred around the world, rising to become an international global health concern at pandemic level. In the face of this medical challenge threatening humans, the development of rapid and accurate methods for early screening and diagnosis of COVID-19 became crucial to containing the emerging public health threat, and prevent further spread within the population. Despite the large number of COVID-19 confirmed cases in China, some problematic cases with inconsistent laboratory testing results, were reported. Specifically, a high false-negative rate of 41% on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection by real-time reverse transcription-polymerase chain reaction (qRT-PCR) assays was observed in China. Although serological testing has been applied worldwide as a complementary method to help identify SARS-CoV-2, several limitations on its use have been reported in China. Therefore, the use of both qRT-PCR and serological testing in the diagnosis of COVID-19 in China and elsewhere, presented considerable challenges, but when used in combination, can be valuable tools in the fight against COVID-19. In this review, we give an overview of the advantages and disadvantages of different molecular techniques for SARS-CoV-2 detection that are currently used in several labs, including qRT-PCR, gene sequencing, loop-mediated isothermal amplification (LAMP), nucleic acid mass spectrometry (MS), and gene editing technique based on clustered regularly interspaced short palindromic repeats (CRISPR/Cas13) system. Then we mainly review and analyze some causes of false-negative qRT-PCR results, and how to resolve some of the diagnostic dilemma.

目的 目前我国侵袭性酵母菌发病率呈明显上升趋势,本研究旨在分析中国医院侵袭性真菌监测网(China Hos-pital Invasive Fungal Surveillance Net,CHIF-NET)2012年流行病学数据.方法 研究数据来自中国的22家三级医院,共收集到1619株念珠菌.研究采用基质辅助激光解析电离飞行时间质谱,结合ITS测序技术进行菌种鉴定,用美国临床和实验室标准协会(CLSI)推荐的纸片扩散法(kirby-Bauer,K-B)测定氟康唑和伏立康唑药物敏感性.结果 本研究标本类型中来自于外周血液标本的菌株626株,占38.67％,来自其他部位(包括腹水、脓肿、静脉导管、脑脊液、肺泡灌洗液、胆汁、胸水、组织、关节积液和胃液)标本993株,占61.33％,其中分离自腹水的菌株354株占21.87％,分离自脓肿的菌株159株占9.82％,分离自其余标本类型的菌株数量较少(＜8％).1619株念珠菌分离自除血液以外其他部位的菌种,以白念珠菌为主(491株占49.45％),其次为热带念珠菌(164株占16.52％),其余种数量较少(＜11％).检出侵袭性酵母菌患者中男性1006株占62.1％,女性612株占37.8％,年龄范围0～94岁,其中≥65岁患者498株占30.76％.在侵袭性念珠菌感染中,绝大部分白念珠菌对氟康唑和伏立康唑敏感[耐药率(R)＜1％],其次为近平滑念珠菌(R＜6％)及热带念珠菌(R＜7％).另外,不同念珠菌在不同的医疗机构有分布差异.结论 中国侵袭性酵母菌感染的分布与多种因素有关,包括感染部位、地域、年龄等,故仍需持续监测.

Candida parapsilosisis an important species causing invasive candidiasis (IC) in China. The present survey was a national multicenter study of the molecular epidemiology and antifungal susceptibility profiles ofC. parapsilosis. Non-duplicateC. parapsilosisisolates were collected from 10 hospitals across China in the CHIF-NET program 2016-2017. Isolates were genotyped using four highly polymorphic microsatellite markers, and susceptibility profiles determined using Sensititre YeastOne(TM)YO10. A total of 319C. parapsilosisfrom separate patients with IC were studied; 49.2, 17.9, and 10.3% isolates were from patients in surgical departments, general intensive care units (ICUs) and neonatal ICUs (NICU), respectively.C. parapsilosisshowed good susceptibility to nine antifungal drugs. Microsatellite analysis identified 122 microsatellite (MT) types. Most MT types had sporadic distribution. However, we identified 32 clusters across 10 hospitals; seven clusters were caused by seven endemic genotypes involving five or more isolates in hospitals designated as H01, H02, H06, and H10. These clusters mainly affected surgical departments and ICUs, except for genotype MT42 which was seen in 22 patients from NICU (hospital H06). Of 16 fluconazole-resistant isolates, seven from hospital H02 shared the same genotype MT70, and three from hospital H04 were of genotype MT47. For 37 isolates with non-wild type MICs to 5-flucytosine, 29 were from hospital H01 (genotype MT48). Here we present the first nationwide molecular epidemiology study ofC. parapsilosisin China, identified several previously unrecognized clusters, which included antifungal drug resistant isolates. These findings provide important data for control of IC in China.

目的 本研究报告了2011年中国医院侵袭性真菌监测网的监测情况.方法 包括来自中国的24家三级医院,共收集到1407株假丝酵母.采用基质辅助激光解析电离飞行时间质谱结合内转录间隔区(ITS)测序技术确定到种,用临床实验室标准化纸片扩散法测定氟康唑和伏立康唑药物敏感性.结果 共鉴定出17种假丝酵母.白假丝酵母是最常见的菌种(48.61％),其次是热带假丝酵母(19.05％)、近平滑假丝酵母复合体(15.21％)和光滑假丝酵母(11.02％),其他种数量较少(<7％).标本类型中,从血流中分离得到假丝酵母最多(42.29％),其次是腹水(25.52％)、脓液(8.53％)、静脉导管(6.18％)和胆汁(5.33％),其他标本分离量较少(<5％).在假丝酵母感染病例中,白假丝酵母和近平滑假丝酵母复合体大多对氟康唑和伏立康唑敏感(耐药株<5％).热带假丝酵母对氟康唑和伏立康唑也大多敏感(耐药株<6％).光滑假丝酵母对于氟康唑和伏立康唑的交叉耐药率较高(14.19％).此外,菌株耐药情况与地域分布有关.结论 中国真菌分布与国际其他地区有明显差异.对真菌耐药,仍需持续性的加强监测.

目的 评估显色药敏板Sensititre YeastOne与微量肉汤稀释法检测曲霉体外抗真菌药物敏感性的一致性.方法 使用同样的孢子悬液按照CLSI M38-A2微量肉汤稀释法和Sensititre YeastOne YO10对307株曲霉进行体外抗真菌药物敏感性试验,计算两种药敏方法结果 间的基本一致性、分类一致性以及错误率.结果CLSI M38-A2药敏试验显示98.4％(302/307)曲霉菌株对测试的6种抗真菌药物持野生型状态,Sensititre YeastOne则检出97.1％(298/307)菌株为野生型.除伊曲康唑外,其余5种抗真菌药物在Sensititre YeastOne与CLSI M38-A2间的基本一致性均>90％.两种方法在曲霉药物敏感性检测的分类一致性为98.1％(301/307),极显著错误率为0.3％(1/307),显著错误率为1.6％(5/307).结论 Sensititre YeastOne在检测曲霉体外药物敏感性方面与CLSI方法一致性良好,可用于临床实验室曲霉体外药敏检测.

Background/purpose: As the incidence of fungal infections in China increases, the demand for rapid and accurate diagnosis of mycoses is growing. Yet, information on current diagnostic capacity is scarce. Methods: An online survey was conducted in February 2018 to collect information on mycology testing from tertiary care hospitals across China. Responses from 348 hospitals were analyzed, and a scoring system was designed and employed to assess the overall diagnostic capacity. Results: Most of the surveyed hospitals did not have separate laboratory space, manpower, or equipment dedicated for fungal testing. Conventional staining methods were widely available (>70%), whereas GMS and fluorescent staining were less common. Fungal identification services were offered mostly with chromogenic medium, morphological characterization or automated identification systems, other than more advanced methods such as MALDI-TOF MS and DNA sequencing. Fungal serology testing was available in 81.1%, with G test being the most often used. Though 91.8% of the respondents had the ability to perform antifungal susceptibility testing for yeasts, less than 13% conducted such testing for molds. The percentage of laboratories participating in External Quality Assessment programs and research was 57.5% and 32.5%, respectively. The average score for the 348 surveyed hospitals was 37.2 (out of a maximum of 89 points), with only 15 hospitals scoring >60, suggesting a general lack of high-quality mycology laboratories. Conclusions: The overall clinical testing capacity for fungal infection in China is insufficient. More investment and training efforts are warranted to establish centers of excellence and promote access to high-quality diagnostic services. Copyright (C) 2020, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC.

目的 评估菌株培养条件、培养天数以及结果判定截断值(cut-off value,COv)3种因素对基质辅助激光解吸电离飞行时间质谱(matrix assisted laser desorption ionization-time of flight mass spectrometry,MALDI-TOF MS)鉴定丝状真菌能力的影响.方法 将78株受试丝状真菌分别接种到沙堡弱葡萄糖琼脂(sabouraud dextrose agar,SDA)、土豆葡萄糖琼脂(potato dextrose agar,PDA)两种培养基及28、35℃两种培养温度共4种组合的培养条件下进行培养,并于培养第2、3、4、5天以及第7天对其进行MALDI-TOF MS分析,根据鉴定率的差异筛选菌株MALDI-TOF MS鉴定用最佳培养条件和培养天数;下调MALDI-TOF MS结果判定COV,分析其对MALDI-TOF MS丝状真菌鉴定率的影响.结果 受试菌株在SDA和PDA两种培养基间的MALDI-TOF MS鉴定率无显著性差异(x2=0.467,P=0.792),但28℃培养温度下的鉴定率高于35℃培养温度(x2=7.195,P=0.027);培养第2、3天种水平(40.3％和34.3％)和属水平(44.8％和46.3％)鉴定率均较高;将MALDI-TOF MS种水平判定COV由＞2.0下调至＞1.7后,受试菌株种水平判定率显著提升(85.9％比32.1％,x2 =40.119,P＜0.01)且不增加错误鉴定率.结论 丝状真菌以SDA或PDA培养基28℃培养2～3d,并以分值＞1.7作为种水平判定COV,可有效提高MALDI-TOF MS对丝状真菌的鉴定能力.