呼吸道标本分离的假丝酵母菌分布及耐药性

Distribution and drug resistance of Candida from respiratory tract specimens

目的调查近年住院患者呼吸道标本分离的假丝酵母菌属菌种分布及耐药性变化趋势,为临床合理使用抗真菌药物提供依据。方法对青岛中心医疗集团所属各医院2007—2011年38326例住院患者送检的呼吸道标本,采用沙保罗培养法培养;VITEX32全自动细菌培养系统YBC鉴定卡或FUNGSCA20进行酵母菌鉴定;ATBFUNGUS3真菌药敏试验板进行药敏试验。应用WHONET5.4软件对药敏结果进行分析。结果 38326份送检标本共分离假丝酵母菌属2745株(7.16%),其中白假丝酵母菌2036株(74.17%),热带假丝酵母菌348株(12.68%),光滑球拟酵母菌118株(4.30%),副秃发酵母菌57株(2.08%),克柔假丝酵母菌57株(2.08%),其他假丝酵母菌129株(4.70%)。假丝酵母菌属对常用抗真菌药物的耐药率从高至低依次为伊曲康唑、氟康唑、伏立康唑、氟胞嘧啶、两性霉素B。经χ2检验,所有假丝酵母菌对氟胞嘧啶、两性霉素B、氟康唑的耐药率,2007—2011年无变化(两两比较,P>0.05);对伊曲康唑、伏立康唑的耐药率,2007—2011年有所上升(两两比较,P<0.05)。结论呼吸道感染的假丝酵母菌属以白假丝酵母菌为主;对抗真菌药物已出现不同程度的耐药,并呈增加趋势。

Objective To investigate the distribution and drug resistance of Candida spp. from respiratory tract of inpatients in recent years, and provide reference for rational use of antifungal agents. Methods Respiratory specimens from 38 326 inpatients in several hospitals between 2007 and 2011 were cultured by Sabouraud agar culture, and Candida were identified by VITEK 32 or FUNGS CA20;antifungal susceptibility testing of Candida was performed by AT FUNGUS 3. WHONETS. 4 software was used for analyzing antifungal susceptibility testing result. Results A total of 2 745 （7. 16%）Candida isolates were isolated, including 2 036 （74. 17%）isolates of Candida albicans, 348 （12. 68%） of Candfda tropicalis, 118（4. 30%）of Torulopsis glabrata, 57 （2. 08%） of Candida parapsilosis, 57 （2. 08%）of Candida krusei, and 129 （4. 70%）of other types of Candida. Resistant rate of fungi from high to low were itraconazole, fluconazole, voriconazole, fiucytosine and amphotericin test showed that drug resistance rate of all Candida to flucytosine, amphotericin B and fluconazole didn＇t change from 2007 to 2011 （P〈0. 05）, while resistance rate to itraconazole and voriconazole increased（P〈0. 05）. Conclusion The major Candida spp. in respiratory infection are Candida albicans, the resistant rate to antifungal agent is increasing.