假丝酵母菌性阴道炎的菌种分类及耐药性监测

Distribution and antimicrobial resistance of species causing Candidavaginitis

目的调查了解医院收治的假丝酵母菌性阴道炎患者的感染性真菌的菌种分类及其耐药性,为临床医师治疗假丝酵母菌性阴道炎选择有效抗真菌药物提供实验室参考依据。方法严格按照卫生部临床检验中心颁发的《全国临床检验操作规程》,无菌手法采集女性患者阴道分泌物立即送检;采用临床常规方法进行真菌分离培养、鉴定假丝酵母菌菌种;采用丹麦Rosco纸片扩散法进行真菌药物敏感试验和判断结果,同时进行室内质控。结果 223例假丝酵母菌性阴道炎患者的生殖道分泌物中培养出231株假丝酵母菌属,包括5个菌种,其中白色假丝酵母菌检出率占第1位,占75.1%,第2位热带假丝酵母菌占9.1%,第3位近平滑假丝酵母菌占5.6%,光滑假丝酵母菌和克柔假丝酵母菌分别占5.2%、6.5%;5种假丝酵母菌对两性霉素B、制霉菌素均保持了100.0%的敏感率;对氟康唑、克霉唑、伊曲康唑等常用抗真菌药物的耐药率分别达到5.4%、22.3%、5.4%。结论假丝酵母菌性阴道炎的致病性真菌除对两性霉素B、制霉菌素100.0%敏感以外,对其他3种常用抗真菌药物已产生了不同程度的耐药性,应重视假丝酵母菌属耐药性监测工作,以指导临床医师正确选择抗真菌药物进行治疗。

OBJECTIVE To investigate the species distribution and antimicrobiai resistance of Candida isolated from patients with monilal vaginitis so as to provide the reference for clinical use of antifungal drugs. METHODS Referring to National Guide to Clinical Laboratory Operation Procedures, the vaginal secretions were collected by aseptic technique and were submitted for the detection immediately. The Candida were isolated and identified by the routine method. The susceptibility testings were performed by K-B method. The testing results were assessed. Simultaneously, the indoor quality control was performed. RESULTS Of 223 vaginal secretions specimens, totally 231 strains of Candida were isolated,including 5 species, among which the Candida albicans （75.1%） ranked the first place, Candida tropicalis （9.1%） the second, and Candida parapsilosis （5.6%） the third, respectively; the Candida glabrata and Candida krusei accounted for 5.2% and 6.5%, respectively. The drug susceptibility rates of the five species of Candida remained 100.0% to amphotricin B and nystatin; the drug resistance rates to such common antibiotics as fluconazole, clotrimazole and itraconazole arrived at 5.4%, 22.3% and 5.4%, respectively. CONCLUSION Except for 100. 0% susceptibility to amphotericin B and nystatin, the pathogenic fungi causing the Candida vaginitis vary in the drug resistance to other three common antifungal drugs. We should attach importance to the monitoring of drug resistance of Candida so as to guide the reasonable use of antifungal drugs.