2005-2006年眼部真菌感染的病原学及药物敏感性分析

Etiological analysis and in vitro drug resistance on the ocular fungal infection in the period of 2005-2006

目的分析眼部真菌感染的菌属分布变化及其体外药敏试验。设计回顾性研究。研究对象北京市眼科研究所2005-2006年1246份眼部可疑真菌感染标本。方法标本接种于沙保罗培养基,在28℃、40%湿度环境下培养8-10天,并应用纸片法分析培养阳性真菌菌株对常用抗真菌药物的敏感性。主要指标菌属种类与季节分布;真菌菌株对那他霉素、特比萘芬、伊曲康唑、氟康唑、两性霉素B的敏感性。结果1246份标本中,真菌培养阳性330株(26.5%)。其中来自角膜、房水、玻璃体、结膜、睑板腺及其他眼组织的比例分别为92.4%、2.7%、1.5%、0.6%、1.0%、1.8%。培养阳性菌株72.4%分布在9月到次年2月,在3～8月者占27.6%。镰刀菌属占64.55%,曲霉属13.03%。对那他霉素、特比萘芬、伊曲康唑、氟康唑、两性霉素B的敏感性分别为88.18%、35.15%、11.82%、5.76%及33.64%。镰刀菌属对那他霉素最敏感,其次是特比萘芬和两性霉素B;曲霉属对特比萘芬最敏感,其次是两性霉素B和那他霉素。结论镰刀菌属和曲霉属是我国北方眼部真菌感染最主要的致病菌。绝大多数真菌菌株对那他霉素、特比萘芬和两性霉素B敏感,对伊曲康唑和氟康唑的耐药性较高。(眼科,2008,17:44-47)

Objective To analyze the distribution and shifting trends of lunged culture specimens and assess the drug susceptibility in vitro. Design Retrospective study. Participants 1246 suspicious fungus infected ocular specimens, from Department of Microbiology, Beijing Institue of Ophthalmology during a period of 2 years （2005-2006）. Methods All specimens were cultured on Sabouraud＇s medium under 28℃, 40% humidity for 8-10 days. Drug susceptibilities were evaluated by K-B method. Main Outcome Measures Distribution of fungus isolates, susceptibility of the fungal culture-positive samples to natamycin, terhinafine, itraconazole, fluconazole and amphotericin B. Results In 1246 specimens, 330 samples （26.5%） were culture-positive outcome, in which 92.4% were from cornea, 2.7% from anterior chamber, 1.5% from vitreous body, 0.6% from conjunctiva, 1.0% from Meibomian gland of eyelids, 1.8% from other parts of eye. 72.4% of strains were collected from September to February of next year; 27.6% from March to August. Fusarium sp. was the commonest pathogen in 64.55%, Aspergrium sp. in 13.03%. The susceptibility in vitro to natamycin, terhinafine, itraconazole, fluconazole and amphotericin B were 88.18%, 35.15%, 11.82%, 5.76% and 33.64%, respectively. Fusarium sp. showed significantly higher susceptibility to natamycin （90.6%）, terhinafine （16.0%） and amphotericin B （12.2%）, and Aspergrium sp. to terhinafine （90.1%）, amphotericin B （72.1%） and natamycin （58.1%）. Conclusions Fusarium sp. and Aspergrium sp. are the predominant pathogens of mycotic ocular diseases in northern China. Most of fungal isolates are susceptible to natamycin, terbinafine, and amphotericin B, whereas most isolates are resistant to itraconazole and fluconazole.