妇科门诊患者外阴阴道念珠菌病的检出率和抗真菌药物敏感性研究

Prevalence of vulvovaginal candidiasis and antifungal susceptibility in gynecologic clinic women

目的 调查妇科门诊患者外阴阴道念珠菌病 (VVC)的发病率 ,对检出的VVC进行真菌培养和药敏试验。方法 连续对 1 0 0 0例妇科门诊患者进行VVC发病情况调查。采用Etest法对检出的 1 2 3例株念珠菌进行体外抗药敏试验。结果 妇科门诊患者VVC的发病率为 1 2 3% (1 2 3/ 1 0 0 0 )。 2 2 3% (2 2 3/ 1 0 0 0 )的患者以往曾有过VVC病史 ,1 3% (1 3/ 1 0 0 0 )的患者为复发性VVC ,占VVC的 8 9% (1 1 / 1 2 3)。 1 2 3例证实的VVC病例中 ,白念珠菌、光滑念珠菌、热带念珠菌和克柔念珠菌分别占 94 3% (1 1 6 / 1 2 3)、 7 1 % (8/ 1 1 3)、 1 6 %(2 / 1 2 3)和 0 8% (1 / 1 2 3)。有 4例患者为两种念珠菌混合感染 ,分别为白念珠菌和光滑念珠菌 (2 )及白念珠菌和热带念珠菌 (2 ) ,混合感染率为 3 3% (4 / 1 2 3)。两性霉素B、伊曲康唑、酮康唑、氟胞嘧啶和氟康唑对 1 1 6株白念珠菌的MIC90依次为 0 38、 2 0、 0 2 5、 1 0、 1 6 μg/ml;白念珠菌对两性霉素B、伊曲康唑、酮康唑、氟胞嘧啶和氟康唑的耐药率依次为 0 9%、 6 9%、 2 6 %、 1 7%和 2 6 %。 8株光滑念珠菌对两性霉素B、酮康唑、氟胞嘧啶均敏感或剂量依赖敏感 ,2株光滑念珠菌对氟康唑耐药 ,8株光滑念珠菌均对伊曲康唑耐药。 2株热带念?

Objective To survey the prevalence of vulvovaginal candidiasis in gynecologic clinic women and to determine the antifungal susceptibility of Candidas to amphotericin B, itroconazole, ketoconazole, flucytosine, and fluconazole. Methods Vaginal swabs were collected from unselected gynecologic clinic women. The antifungal susceptibility of 123 strains of Candidas to amphotericin B, itroconazole, ketoconazole, flucytosine, and fluconazole were detected respectively by E test. Results One thousand women were recruited, of whom 123 were diagnosed with vulvovaginal candidiasis. The prevalence of vulvovaginal candidiasis among gynecologic clinic women was 12 3% 22 3%(223/1 000) of the women had history of VVC and 1 3%(13/1 000) was recurrent VVC, which was 8 9%(11/123)of VVC. C. albicans was detected most frequently (91 3%),followed by C. glabrata (7 1%), C. tropicalis(1 6%) and C. krsei (0 8%).The MIC90 of amphotericin B, itroconazole, ketoconazole, flucytosine, and fluconazole to C.albicans was 0 38 μg/ml, 2 0 μg/ml, 0 25 μg/ml, 1 0 μg/ml and 16 μg/ml, respectively. By following the criteria of the interpretive breakpoints for antifungal susceptibility testing for the antifungal agents against Candidas, the resistant rates of C. albicans against amphotericin B, itroconazole, ketoconazole, flucytosine and fluconazole was 0 9%, 6 9%, 2 6%, 1 7%, and 2 6%. All eight strains of C. glabrata was susceptible or susceptible-dependent-upon-dose (SDD) to amphotericin B, ketoconazole,and flucytosine and was resistance to itroconazole. Two C. glabrata strains were resistant to fluconazole. Both of the C. tropicalis strains were susceptible or SDD to amphotericin B, ketoconazole, flucytosine, and fluconazole. One C. tropicalis strain was resistant to itroconazole. One C. krsei strains was susceptible or SDD to amphotericin B, ketoconazole, flucytosine, itroconazole, and fluconazole. Conclusions Vulvovaginal candidiasis is a common disease of gynecologic clinic women. C. albicans is the predominant Candida species in vulvovaginal candidiasis and shows some resistance to amphotericin B, itroconazole, ketoconazole, flucytosine and fluconazole. C. glabrata is susceptible or SDD to amphotericin B, ketoconazole and flucytosine, yet partially resistant to fluconazol, and is resistance to itroconazole.