临床酵母样真菌耐药性监测与分析

Monitoring and analysing of drug resistance of yeast-like fungus

目的分析本院2006年1～12月的酵母样真菌的耐药现状及其发展趋势。方法用科玛嘉真菌显色培养基分离真菌,用VITEK YBC板条进行鉴定,用ATB Fungus2（生物梅里埃中国有限公司）检测真菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑等4种抗真菌药的耐药结果。结果6199例送检标本中共检出279例酵母样真菌,真菌阳性率达4.5%,其中以白色念珠菌的检出率最高,占检出真菌的57.34%,其次为热带念珠菌19.00%,光滑念珠菌11.82%,近平滑念珠菌6.45%;276例酵母样真菌的药敏结果：氟康唑、伊曲康唑耐药率分别为6.2%～27.8%和11.9%～27.3%,未检测出耐5-氟胞嘧啶、两性霉素B的菌株。结论由于广谱抗生素、免疫抑制剂和抗肿瘤药物的广泛使用,使真菌的感染率不断上升,尤其以白色念珠菌最为明显,耐药现象不断加强。医务人员应重视对真菌的检测和耐药性的监测工作,以指导临床合理使用抗真菌药物。

Objective To analyze the condition and tendency for drug resistance of yeast-like fungus from Jan 2006 to Dec 2006 m our hospital. Methods Fungi was isolated by CHRM agar medium. Identification of fungi was performed by YBC batten. The resistance to antifungal agents, such as 5-flucytosine, amphotericin B, fluconazole and itraconazole was detected by ATB fungus 2 analysis system. Results 276 strains of yeast-like fungus were isola- ted from 6 199 samples, and the isolated rate of fungus was 4.5 %. The isolated rate of C. Albicans,C. Tropical, C. Glabrata and C. Parapsilosis was 57.34%, 19.00% ,11.82% and 6.45% respectively. The drug resistance rates of yeast-like fungus were as follows： fluconazole 6.2%- 27.8% ;itraconazole 11.9%- 27.3%. The yeast-like fungus resistance to antifungal agents, such as 5-flucytosine and amphotericin B wasn＇t found. Conclusion The abuse of broad-spectrum antibiotics, immunosuppressants and antineoplatics accelarates the infection and drug resistance of fungi and antifungal sensitivity test should be strengthened so as to guide clinical selection of antibiotics rationally.