医院感染念珠菌菌种分布及耐药情况分析

Species distribution and drug resistance in nosocomial infections with Candida

目的分析两所不同地区三甲综合医院分离的医院感染念珠菌的菌种分布、临床特点以及耐药情况。方法收集发生念珠菌感染住院患者的临床资料、标本。念珠菌显色培养基、ATB-ID 32C酵母鉴定试剂条以及26S rDNA区扩增测序鉴定念珠菌菌种;ATB FUNGUS药敏试剂条测定药物敏感性。结果共收集医院感染念珠菌标本396份,主要为白念珠菌(川北医附院/华西医院:68.1%/70.2%)、热带念珠菌(14.9%/9.0%)、光滑念珠菌(5.7%/12.2%)、克柔念珠菌(3.4%/2.4%)、近平滑念珠菌(2.1%/1.6%)。高发科室主要在ICU、感染科、呼吸科及普外科。感染部位以下呼吸道最常见。对两性霉素B的敏感性最高,而对氟康唑有不同程度的耐药。结论应重视念珠菌耐药的检测、菌种培养鉴定及药敏试验,合理应用抗生素,降低院内念珠菌感染率及耐药株产生。

Objective To analyze the species distribution and drug resistance of Candida isolated from two Class 3-A general hospitals （Affiliated Hospital of North Sichuan Medical College/West China Hospital） from different regions. Methods Clinical data and samples were collected from patients with nosocomial infections caused by Candida. Candida were cultured and identified by using CHROM agar, ATB-ID 32C Yeast Identified Reagent Strips and sequencing of 26S rDNA. The drug resistance testing of Candida to itraconazole, fluconazole, amphotericin B and 5-flucytosine were performed by ATB FUNGUS method. Results Totally 396 strains of Candida were collected. The infection rate of C.albicans were as high as 68.1%/70.2%, followed by C.tropicalis（14.9%/9.0%）, C.glabrata （5.7%/12.2%）, C. krusei（3.4%/2.4%） and C. parapsilosis（2.1%/1.6%）. These Candida strains were mainly isolated from intensive care unit, infectious department, pneumology department and department of general surgery. The main site of nosocomial fungal infection was the lower respiratory tract. Drug sensitive test including these four antifungal agents shows best sensitivity to amphotericin B and resistance to fluconazole at some extent. Conclusion The incidence of nosocomial infections caused by Candida and the infection rate of non-C.albicans have been increasing by years. In order to reduce the incidence and resistance of nosocomial Candida infection, we should strengthen the monitor of Candida drug resistance and emphasize species culture and identification and drug sensitive test, as well as rational application of antibiotics.