复发性外阴阴道假丝酵母菌病致病菌的药敏及其基因分布

Susceptibility Testing and Genome Distribution of Recurrent Vulvovaginal Candidiasis

目的探讨复发性外阴阴道假丝酵母菌病(RVVC)病原体的药敏情况及其基因CDR1、CDR2、ERG11、CaMDR1和FLU1的分布状况。方法采取60例RVVC患者的白带标本,于科玛嘉念珠菌显色平板上培养,Vitek-2全自动细菌鉴定仪进行菌株鉴定,纸片法进行药敏试验;以PCR扩增法检测CDR1、CDR2、ERG11、CaMDR1和FLU1基因分布。结果 60份白带标本分离出60株假丝酵母菌,其中白色假丝酵母菌、光滑假丝酵母菌、热带假丝酵母菌、克柔假丝酵母菌、乳酒假丝酵母菌分别占73.3%、15.0%、6.7%、3.3%、1.7%;假丝酵母菌株对咪康唑的耐药率最高为21.7%,其次是5-氟尿嘧啶为13.3%,对氟康唑、伊曲康唑、两性霉素B的耐药率分别为8.3%、6.7%、5.0%。PCR耐药基因组检测CDR1、CDR2、ERG11、CaMDR1和FLU1阳性率分别为63.3%、61.7%、58.3%、63.3%、1.7%。44株白色假丝酵母菌株对咪康唑耐药株11株、敏感株29株、中介4株,其中耐药株CDR1、CDR2、ERG11、CaMDR1阳性表达率分别为81.8%、72.7%、72.7%、72.7%,高于敏感株的34.5%、31.0%、27.6%、37.9%(P均<0.05),FLU1阳性率差异无统计学意义(P>0.05)。结论假丝酵母菌对临床常用的抗真菌药物存在一定的耐药性,耐药基因CDR1、CDR2、ERG11、CaMDR1在多种假丝酵母菌株中均有表达。

Objective To investigate the susceptibility testing of recurrent vulvovaginal candidiasis （ RVVC） and distribution of its genome CDR1,CDR2,ERG11,CaMDR1 and FLU1.Methods The vaginal specimens were collected from 60 patients with RVVC , which were cultured on the CHROMagar candida chromogenic culture plate . Vitek-2 automated bacterial identification system was applied to strain identification ,and the disk diffusion method was used for susceptibility testing .PCR amplification was used to detect the distribution of CDR 1 ,CDR2 ,ERG11 ,CaMDR1 and FLU1 genes .Results Sixty strains of Candida were isolated from 60 vaginal specimens ,in which Candida albicans , C.glabrata,Candida tropicalis,Candida krusei,Candida kefyr accounted for 73.3%,15.0%,6.7%,3.3%,1.7%, respectively;The highest drug resistance rate of Candida strains to miconazole was 21.7%,followed by that of 5-fluorouracil （13.3%）,the drug resistance rates of fluconazole ,itraconazole,amphotericin B were 8.3%,6.7%,5.0%,respectively.The positive rates of CDR1,CDR2,ERG11,CaMDR1 and FLU1 detected with PCR amplification were 63.3%,61.7%,58.3%, 63.3%,1.7%,respectively.Of 44 strains of Candida albicans,11 were resistant to miconazole strains,29 were sensitive strains,4 were intermediary strains ,the positive expression rates of resistant strains of CDR 1,CDR2,ERG11,CaMDR1 were 81.8%,72.7%,72.7%,72.7%,respectively,higher than those （34.5%,31.0%,27.6%,37.9%） of sensitive strains （ all P〈0.05）,the positive expression rate of FLU1 showed no significant difference between resistant strains and sensitive strains （ P 〉0 .05 ） .Conclusion Candida is resistant to the clinical common antifungal drugs , the drug resistance genes CDR1,CDR2,ERG11,CaMDR1 are expressed in different strains of Candida .