念珠菌临床感染与耐药性研究

Infection of candida:a clinical and drug resistance investigation

目的:分析念珠菌感染的临床特点,检测4种抗真菌药物对念珠菌的体外抗菌活性。方法:对临床分离的410株念珠菌用科玛嘉念珠菌显色培养基和VITEK60微生物鉴定仪进行鉴定,E-test法测定伊曲康唑、酮康唑、氟康唑和两性霉素B对62株念珠菌的最低抑菌浓度(M IC)。结果:410株念珠菌源于痰标本的243株,占59.2%,尿标本117株,占28.5%,粪便标本22株,占5.4%;其中白色念珠菌237株,占57.8%,光滑念珠菌92株,占22.4%,热带念珠菌62株,占15.1%,克柔念珠菌11株,占2.7%,其他念珠菌8株,占2.0%;两性霉素B和酮康唑对5种主要念珠菌的体外抗菌活性均较好,氟康唑、伊曲康唑对光滑念珠菌和克柔念珠菌均呈现较高的耐药性,并出现白色念珠菌耐药株。结论:临床感染的真菌仍以白色念珠菌为主,非白色念珠菌的感染有上升趋势;大多念珠菌感染患者有高龄、基础疾病、广谱抗生素使用等问题;抗真菌药物对念珠菌的耐药性分布具有明显的种间差异。唑类药物的耐药现象应引起临床高度重视。

Objective：To investigate the infection characteristic of candida and detect the susceptibility of four antifungal agents against candida.Methods：The 410 strains were identified by using CHROMAGAR culture medium as well as VITEK60-AMS,E-test method was used to test the Minimum inhibitory concentration（MIC） of itroconazole,ketoconazole,fluconazole and amphoteriin against 62 strains.Results：The source of 410 strains were from sputum,urine,stool,respectively 243（59.2%）,117（28.5%）,22（5.4%）;C.albicans accounted for 237（57.8%）,followed by C.glabrata 92（22.4%）,C.tropicalis 62（15.1%）,C.krusei 11（2.7%） and others 8（2.0%）,amphoteriin B and ketoconazole had higher in vitro antimicrobial activity to all Candida;fluconazole and itroconazole had higher resistance to C.glabrata and C.krusei,and there were resistant species of C.albicans.Conclusion：The most common species in the clinical isolates were still C.albican,with non-albicans species appears increasing.Most cases were aging,various predisposing diseases and plentiful use of antibiotics.The resistance of antifungus had obvious interspecific differences on candida.The resistance of azole antifungals should be paid close attention to.