念珠菌引起深部感染的病原学特征与药敏试验

Etiological characteristics and drug sensitivity outcomes of deep infection caused by Candida spp

目的了解近年来深部念珠菌感染的病原学特征和医院内深部真菌感染现状,为临床提供病原学诊断和合理使用抗真菌药物的依据。方法血培养使用BacT ALERT 3D血培养检测仪,其他各种临床标本用沙堡培养基培养,科玛嘉念珠菌显色培养基分离鉴定念珠菌;用ATB Fungus 2药敏卡对菌株进行体外药物敏感试验。结果3年间从深部标本中共分离出念珠菌2256株,菌种分布依次为:白色念珠菌(72.61%)、光滑念珠菌(10.28%)、克柔念珠菌(9.40%)、热带念珠菌(4.97%)、其他念珠菌(2.74%);162株念珠菌药敏结果:5-氟胞嘧啶、两性霉素对所有念珠菌敏感度都很高,但各种真菌对4种抗真菌药物均出现了不同程度的耐药。结论白色念珠菌仍为主要的致病真菌,但非白色念珠菌所占比例有逐年上升的趋势。不同念珠菌对常用抗真菌药物敏感性存在差异,准确分离鉴定和药敏试验,对指导临床医生合理用药有重要意义。

Objective To renew the recent etiological characteristics and current status on nosocomial deep infection with Candida spp and to provide evidences for microbiological diagnosis and proper use of anti fungal agents. Methods The fungi were cultured using BacT ALERT 3D （for blood samples） and Saboraud medium （for other sam- pies）, and identified for Candida spp using CHRO-Magar Candida color medium. Susceptibility to antifungal agents was detected with ATB fungus 2 system. Results From January 2004 to December 2006, a total of 2256 strains of Candida spp from deep infected specimens were isolated. The most common strain detected was C. albicans （72.61%）, followed by C. glabrata （10.28%）, C. krusei （9.40%） and C. tropicalis （4.97%）. Drug sensitivity test showed considerably high antifungal activities with 5-Fluorocytosine and Amphotericin. However, varied degrees of drug resistance to the four anti-fungal agents studied were also found in each of the species. Conclusion Infection with non-albicans species appears increasing, despite that C. albicans remains the most common pathogenic Candida species. Different species of Candida spp may show varied susceptibility to common anti-fungal agents. Therefore, accurate information on species identification and drug sensitivity should help proper antifungal treatment in clinical practices.