209株临床分离的不同基因型白假丝酵母菌和丝状真菌的抗真菌药物敏感性及其耐药性趋势研究

Study on antifungal susceptibilities and resistance trends of 209 strains of C. albicans with various genotypes and filamentous fungi isolated from clinical specimens

目的了解常见致病性真菌的药物敏感性及其耐药性趋势。方法检测临床分离白假丝酵母菌和丝状菌的抗真菌药物敏感性。结果176株白假丝酵母菌A型（55．1％）、B型（29．O％）和c型（15．9％）的FC和AP敏感率较高（88．7％-100％），FL、IT及VR敏感率较低（小于26％）。各基因型菌株在FC、AP、FL、IT、VR敏感性无明显差异（P〉0．05），在FC与AP、FL、IT、VR，AP与FL、IT、VR之间存在显著的敏感率差异（P〈0．001）。33株丝状菌的MIC值，9株（27．3％）AP≥3μg／mL，7株（21．2％）FC≥3μg/mL，32株（97％）FL〉256μg／mL。各菌株的FC、AP、FL、IT、CS敏感率有差异，AP与FL、CS，IT与FL、CS，FC与FL、CS，FL与CS之间的敏感率差异显著（p=0．001）。结论白假丝酵母菌基因A型、B型和C型对所测试抗真菌药物的敏感性无明显差异。白假丝酵母菌和丝状菌多数菌株表现出较高的耐药率和明显的耐药性发展趋势。

Objective To investigate the antifungal susceptibilities and resistance trends of the pathogenic fungi. Methods With the method of minimum inhibitory concentration （MIC） test, the susceptibilities and the trend of drug-resistance to flucytosine, amphotericin B, fluconazole, itraconazole, voriconazole and/or caspofungin of 176 strains of C. albicans and 33 filamentous fungi which were isolated from patients with infectious diseases were detected. Results 176 strains of C. albicans, including 97 strains of genotype A （55.1%）, 51 strains of genotype B （29.0%）and 28 strains of genotype C （15.9%）, were sensitive to flucytosine and amphotericin B （sensitivity rate of 88.7% to 100%） but resistant to fluconazole, itraconazole and voriconazole （sensitivity rate 〈26%）. In various genotypes of C. albicans, no significant difference in susceptibility rates of flucytosine, amphotericin B, fluconazole, itraconazole, voriconazole can be found （P〉0.05）. However, the significant difference （P〈0.001） in susceptibility rates of different antifungal drugs can be observed between ftucytosine and other drugs such as amphotericin B, fluconazole, itraconazole and voriconazole; such difference can be also observed between amphotericin B and azole group. In 33 filamentous fungi, MIC values of amphotericin B for 9 strains （27.3%） were ≥ 3 μg/mL, flucytosine for 7 strains （27.3%） were ≥3μg/mL, and fluconazole for 32 strains （97%） were ≥256μg/mL, respectively. The susceptibility differences for the strains existed in flucytosine, amphotericin B, fluconazole, itraconazole and caspofungin. Among them, the significant differences （P〈0.001） in susceptibility rates of these strains can be observed between amphotericin B and fluconazole/easpofungin, between itraconazole and fluconazole/caspofungin, between flucytosine and fluconazole/ caspofungin, and between fluconazole and caspofungin, respectively. Conclusion There is no significant differences existed in the drug susceptibility test for the C. albicans strains with different genotypes A, B and C. Most strains of C. albicans and filamentous fungi displayed the resistance characteristics and showed the resistance tendency to antifungal drugs.