临床标本中深部真菌的分离鉴定及药敏结果分析

Isolation,identification and antifungal drug sensitivity of deep fungus in clinical samples

目的探讨临床送检标本中深部真菌的菌种分布及抗真菌药物的敏感现状。方法按常规方法培养,采用念珠菌显色培养基、小培养、API 20C AUX对念珠菌进行鉴定;药敏试验采用丹麦Rosco公司抗真菌药敏纸片扩散法。结果257株真菌标本中,念珠菌属248株,占96.50%;丝状真菌9株,占3.5%。分离的菌株以白色念珠菌为最多(54.86%),其次为光滑念珠菌(19.84%)和热带念珠菌(9.73%)。念珠菌对抗真菌药物的敏感率依次为两性霉素B(100.00%)、制霉菌素(100.00%)、5-氟胞嘧啶(87.50%)、伊曲康唑(83.06%)、酮康唑(75.40%)、氟康唑(65.32%)、特比奈芬(40.32%)。结论深部真菌感染以念珠菌属为主,特别是白色念珠菌和光滑念珠菌;不同菌株对常用抗真菌药物的敏感性不同,及时进行真菌体外药敏试验,有利于发现耐药菌株,指导临床选择敏感的抗真菌药物。

Objective To investigate the distribution of fugal species and analyze the antifungal drug sensitivity of deep fungus in clinical samples so as to provide evidence for the reasonable clinical use of anti-epiphyte medicines. Methods Fungi were cultured and identified by CHRO- Magar, Cornmeal and API 20C AUX. Drug sensitivity test were performed by Rosco paper disk diffusion. Results Out of 257 fungi strains, 248 were Candida spp that took 96.5%, the rest 9 were mould strains that took 3.5%. Of the strains isolated in the experiment, the first three were Candida albicans（54.86%）, C. glabrata（19.84%） and C. tropicalis（9.73%）. The sensitivity rates to amphotericin B, nystatin, fiuoroeytosine, itraconazole, ketoconazole, fiuconazole and terbinafine were 100.00%, 100,00%, 87.50%, 83.06%, 75.40%, 65.32% and 40.32%, respectively. Conclusion Candida spp infections are most common in deep fungal infections, especially in Candida albicans and C. glabrata. The tests indicate that there are differences in drug sensitivity for various strains and the duly antifungal sensitivity tests help to find the resistant fungal in order to guide clinical selection of the sensitive antifungal agents.