复发性外阴阴道念珠菌病的病原学特点及药敏分析

The etiologic character of recurrent vulvovaginal candidiasis and drug sensitivity analysis

目的了解复发性外阴阴道念珠菌病(RVVC)致病菌的菌种分布情况及耐药情况。方法运用科玛嘉显色培养基法外阴阴道念珠菌病患者的594株念珠菌进行菌种鉴定和药物敏感试验,其中复发性外阴阴道念珠菌病114例,外阴阴道念珠菌病(VVC)480例。结果114例RVVC病例经鉴定白色念珠菌104株(91.22%),光滑念珠菌6株(5.26%),热带念珠菌3株(2.63%),近光滑念珠菌1株(0.88%),与VVC组比较差异有显著性(P<0.05)。RVVC的念珠菌株对药物的敏感率为制霉菌素(98.25%)>两性霉素(97.37%)>酮康唑(55.26%)>咪康唑和伊曲康唑(36.84%)>氟康唑(23.68%)>特比奈芬(10.53%)。RVVC与VVC组比较,药物制霉菌素、两性霉素、氟康唑和伊曲康唑的敏感率2组差异无显著性(P>0.1);酮康唑的敏感率2组差异有显著性(P<0.05),RVVC组优于VVC组;咪康唑和特奈比芬的敏感率2组差异有显著性(P<0.005),RVVC组明显低于VVC组。结论白色念珠菌是导致临床阴道念珠菌感染的优势菌群,其次有光滑念珠菌,热带念珠菌和近光滑念珠菌等。制霉菌素对阴道内真菌的敏感率最高,是治疗真菌感染的有效药物。鉴于伊曲康唑、咪康唑、氟康唑、特比萘芬等均存在不同程度的耐药,建议对复发性外阴阴道念珠菌病患者根据药敏试验来选择药物,临床治疗VVC必须规范化应用抗真菌药物,首次发作或首次就诊是规范化治疗的关键时期,从而减少耐药菌株的出现,提高治愈率。

[Objective] To understand distribution and drug resistance of the pathogenic strains of recurrent vulvovaginal candidiasis （RVVC）. [Methods] Identification and drug sensitivity tests of 594 Candida strains isolated from the sample of vulvovaginal candidiasis patients were carried out with CHROMagar chromogenic culture media, among which 114 cases were recurrent vulvovaginal candidiasis, 480 cases were vttlvovaginal candidiasis （VVC）. [Results] Among the 114 cases of RVVC, there were 104 strains of Candida albicans （91.22%）, followed by 6 Candida glabrata （5.26%）, 3 Candida tropicalis （2.63%） and 1 C.parapsilosis （0.88%）, showing difference from VVC differences （P 〈0.05）. The drug sensitive rate of Candida albicans strains of RVVC was： nystatin （98.25%）〉 amphotericin （97.37%）〉 ketoconazole （55.26%）〉 miconazole, itraconazole （36.84%）〉 fluconazole （23.68%）〉 terblnafine （10.53%）. Compared with the VVC group, drug sensitive rate in the RVVC group to nystatin, amphotericin, fluconazole and itraconazole showed no significant difference （P 〉0.1）, while significant difference existed in the drug sensitive rate to ketoconazole between the two groups （P 〈0.05） with that of RVVC group superior to that of VVC group; sensitive rate to miconazole and terbinafine were significantly different between the two groups （P〈0.005）, with that of RVVC group significantly lower than that of VVC group. [Conclusion] Candida albicans is the predominant strain causing clinical vaginal candidiasis infection, followed by Candida glabrata, Candida tropicalis and Candida. tropicalis and other Candida Infection. Nystatin is the most sensitive drug to vaginal fungal and thus is the effective drug to treat fungal infection. In view of the drug resistance of itraconazole, miconazole and fluconazole, terbinafine at different levels, it is suggested to select drugs for recurrent vulvovaginal candidiasis patients according to the sensitivity test. Antifungal drug application must be standardized in clinical treatment of VVC with the crucial period lying at the first attack or the first treatment, so as to reduce the emergence of resistant strains and to improve the cure rate.