复发性外阴阴道念珠菌病的致病菌种鉴定及药敏分析

Identification and drug sensitivity tests of the pathogenic strains of recurrent vulvovaginal candidiasis

目的:探究复发性外阴阴道念珠菌病致病菌的菌种分布及耐药情况,指导临床治疗。方法:收集210例念珠菌性外阴阴道炎患者阴道分泌物标本,其中复发性外阴阴道念珠菌病(RVVC)组76例,外阴阴道念珠菌病(VVC)组134例。运用科玛嘉显色培养基法进行菌种鉴定和药物敏感试验。结果:在210例病例中,RVVC组中白色念珠菌54株(71.05%),光滑念珠菌15株(19.74%),热带念珠菌4株(5.26%),克柔念珠菌2株(2.63%),近平滑念珠菌1株(1.32%)。非白色念珠菌中以光滑念珠菌为主,在RVVC组中的比例明显高于VVC组,有显著性差异(P<0.05)。药敏试验显示,RVVC的念珠菌株中仅8株对7种药物全部敏感,23株敏感药物<5种,其中1株仅对制霉菌素敏感;对药物的敏感率为制霉菌素(97.37%)>克霉唑(60.52%)>酮康唑(51.32%)>伊曲康唑(36.84%)>咪康唑(35.53%)>氟康唑(23.68%)>特比奈芬(10.53%)。结论:白色念珠菌仍是RVVC的主要致病菌,非白色念珠菌比例在RVVC组中显著高于VVC组,其中以光滑念珠菌为主。念珠菌对制霉菌素敏感率最高,对唑类药物耐药性有增加趋势。

Objective：To explore the distribution and drug resistance of the pathogenic strains of recurrent vul-vovaginal candidia-sis（RVVC）.Methods：Clinical isolates of vaginal secretion sample were collected from 210 vulvovaginal candidiasis patients,among which 76 cases were recurrent vulvovaginal candidiasis（RVVC）,134 cases were vulvovaginal candidiasis（VVC）.Identification and drug sensitivity tests were carried out with CHROMagar chromogenic culture media.Results：Among the 76 cases of RVVC,there were 54 strains of Candida albicans（71.05%）,followed by 15 Candida glabrata（19.74%）,4 Candida tropicalis（5.26%）,2 Candida kruseii（2.63%） and 1 Candida parapsilosis（1.32%）.Candida glabrata plays the leading role in the non-albicans.The ratio of Candida glabrata in RVVC group was significantly higher than in VVC group（P〈0.05）.Drug sensitivity test showed that 8 strains in RVVC group were sensitive to 7 drugs selected in this study,23 strains were sensitive to less than 5 drugs,one strain in RVVC group was sensitive to nys-tatin only.The drug sensitive rate of Candida albicans strains of RVVC was：nystatin（97.37%）〉 clotrimazole（60.52%）〉 ketoconazole（51.32%）〉 itraconazole（36.84%）〉 miconazde（35.53%） 〉fluconazole（23.68%）〉 terbinafine（10.53%）.Conclusion：Candida albicans plays the leading role in the vulvaginal candidiasis.The ratio of non-albicans which mainly consist of Candida glabrata in RVVC group was significantly higher than in VVC group.The drug-susceptibility rate of Candida albicans to nystatin was the highest.The resistance of candida to triazoles and imidazloes increased,with a trend of ascend.