肺部假丝酵母菌属感染的病原菌构成及耐药性分析

Distribution and drug resistance of Candidacausing pulmonary infections

目的了解肺部假丝酵母菌属感染的病原菌构成及其耐药性变化,指导临床肺部假丝酵母菌属感染经验性抗真菌治疗药物的选择。方法采用VITEK系统对2009年1月-2011年12月住院患者的痰标本进行假丝酵母菌属菌种鉴定;采用微量稀释法对上述分离出的菌株进行耐药性分析。结果从痰标本中分离出1533株假丝酵母菌属菌株,其中白色假丝酵母菌1022株、光滑假丝酵母菌270株、热带假丝酵母菌174株、克柔假丝酵母菌53株、近平滑假丝酵母菌7株、其他菌株7株,分别占66.7%、17.6%、11.4%、3.5%、0.5%、0.5%,2009、2010年和2011年白色假丝酵母菌分别占76.8%、62.2%和66.3%;假丝酵母菌属对氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑的耐药率分别为0.5%、0.3%、5.9%、8.9%和3.2%,其中白色假丝酵母菌对上述药物的耐药率分别为0.1%、0.1%、2.2%、3.2%和1.5%,而非白色假丝酵母菌的耐药率分别为1.2%、0.8%、13.3%、20.4%和6.6%。结论临床治疗肺部假丝酵母菌感染患者时,应考虑到目前白色假丝酵母菌仍旧是临床最常见的致病病原体,但是有逐年下降的趋势;假丝酵母菌属对三唑类药物存在耐药,其中伊曲康唑耐药率最高,三唑类药物之间存在交叉耐药;非白色假丝酵母菌对三唑类药物的耐药率高于白色假丝酵母菌,应慎重选择用药。

OBJECTIVE To investigate the distribution and drug resistance of the Candida causing pulmonary infections so as to guide the empirical antifungal drug therapy for the Candida infections. METHODS The species of Candida from the sputum specimens obtained from the hospitalized patients from Jan 2009 to Dec 2011 were identified with the use of VITEK system, then the drug resistance of the isolated strains was analyzed by using microdilution method. RESULTS A total of I533 strains of Candida have been isolated from the sputum specimens, among which there were 1022 （66.7%） strains of Candida albicans, 270 （17.6%） strains of Candida glabrata, 174 （11.4%） strains of Candida tropicalis, 53 （3.5%） strains of Candida krusei, 7 （0.5%） strains of Candida parapsilosis, and 7 （0.5 %） strains of other Candida spp. The proportion of C. albicans was 76.8% in 2009, 62.2% in 2010, and 66.3% in 2011. The drug resistance rates of the Candida spp to 5-flucytosine, amphotericin B, fluconazole, itraconazole, and voriconazole were 0. 5%, 0. 3%, 5. 9%, 8. 9%, and 3. 2%, respectivelyl the drug resistance rates of the C. albicans to those above antibiotics were 0. 1%, 0. 1%, 2.2%, 3.2%, and 1.5%, respectively, while the drug resistance rates of the non-C, albicans strains were 1.2%, 0.8~~, 13.3%, 20.40//00, and 6.6%, respectively. CONCLUSION For the clinical treatment of pulmonary infections with Candida spp, the C. albicans remains the most common species of pathogen, showing a downward trend. The Candida spp are resistant to the clinically recommended triazoles antibiotics, the drug resistance rate to itraconazole is the highest, and the cross resistance of the strains exists among the triazoles antibiotics; the drug resistance rate of the C. albicans to the triazoles antibiotics is higher than that of the non- C. albicans strains, thus the antibiotics should be used reasonably.