儿科患者中真菌分布及耐药监测

Clinical distribution and resistance surveillance of fungal isolates in children from 2000 to 2006

目的了解我院2000—2006年临床深部真菌感染分离的病原真菌种类及对抗真菌药物的耐药性变化。方法分析2000年1月—2006年12月年我院住院患儿所有送检真菌培养标本中分离出的菌株,药敏试验使用ATB-FUNGUS2INT酵母药敏试条,进行5-氟胞嘧啶、氟康唑和两性霉素B3种抗真菌药敏检测,严格按照2006年CLSI M27-A2规则及标准进行。结果分离出635株真菌中,念珠菌属572株(90.1%),曲霉属29株(4.6%),隐球菌属21株(3.3%),青霉属和酵母属各5株(0.8%),毛孢菌属2株(0.3%),毛霉属1株(0.2%)。念珠菌属中,前3位分离菌是白念珠菌418株(73.1%);光滑念珠菌64株(11.2%);热带念珠菌52株(9.1%)。白念珠菌对5-氟胞嘧啶、氟康唑和两性霉素B敏感率分别为97.6%,97.6%和98.4%。结论儿科患者中分离的真菌中以念珠菌属最多,并以白念珠菌为主,曲霉比率也在增多。5-氟胞嘧啶、氟康唑和两性霉素B均有较高的抗真菌活性。应加强真菌分离鉴定和耐药性监测,供合理选用抗真菌药物的参考。

Objective To investigate current status about fungal isolates from deep fungal infections and the antifungal resistance profile in Beijing Children＇s Hospital. Methods All the isolates collected in our hospital from January 2000 to December 2006 were analyzed. Susceptibility testing was conducted with 5-fluorocytosine, fluconazole and amphotericin B using ATB- FUNGUS 2 INT method. Results were analyzed according to the guidelines of CLSI （Clinical and Laboratory Standard Institute） M27-A2. Results Among the 635 fungal strains, 572 （90. 1%） were Candida spp, 29 （4.6%） were Aspergillus spp, 21 （3.3 %） were Cryptococcus neoformans. The Candida strains included C. albicans （73. 1 %）, C. glabrata （11.2%）, C. tropicalis （9.1%）, C. parapsilosis （2.9%）, C. krusei （2.1%）, and other Candida spp. （1.5%）. The susceptibility rate of C. albicans to 5-fluorocytosine, fluconazole and amphotericin B was 97.6% ,97.6% and 98.4%, respectively. Conclusions Candida strains, especially Candida albicans, are most common species in children with fungal infection. Aspergillus spp. was increasing. 5-fluorocytosine, fluconazole and amphotericin B have good antifungal activity. It is important for clinical laboratory to isolate and identify the potential fungal pathogens and monitor their resistance for rational use of antifungal agents.