白色假丝酵母菌感染的临床分布与药敏及生物膜类型分析

Clinical distribution and drug susceptibility and biological membrane type of Candida albicans infection

目的探讨白色假丝酵母菌感染的临床分布与药敏率以及产膜能力,为临床合理使用抗真菌药物提供科学依据。方法收集2013年1月-2015年8月住院患者标本分离出7 612株真菌,真菌分离培养按《全国临床检验操作规程》进行,采用法国生物梅里埃公司全自动微生物VITEK-2Compact分析仪鉴定到种,体外药敏试验采用纸片K-B法,采用WHONET 5.6软件进行统计分析,通过结晶紫染色法对白色假丝酵母菌进行生物膜定量分析。结果分离的真菌中白色假丝酵母菌1 366株,占17.9%;白色假丝酵母菌主要分离自呼吸科389株及急诊科241株,分别占28.5%及17.6%;白色假丝酵母菌的标本来源主要以痰液最多,其次为尿液及分泌物,分别占68.3%、10.5%及5.8%;白色假丝酵母菌对两性霉素B、伏立康唑、氟康唑、氟胞嘧啶、伊曲康唑的敏感率分别为100.0%、100.0%、99.9%、99.8%、98.0%;标准菌株SC5314为强产生物膜,临床分离的1 366株白色假丝酵母菌中弱产生物膜325株、中等产生物膜243株、强产生物膜798株。结论白色假丝酵母菌对两性霉素B、伏立康唑、氟康唑、氟胞嘧啶、伊曲康唑依然保持较高的敏感性,白色假丝酵母菌的临床分布不同,临床治疗应合理选择抗真菌药物,同时加强对真菌耐药性的监测有助于减少耐药菌株的产生,也推动了生物膜产生能力与白色假丝酵母菌的耐药机理及致病性之间关系的进一步研究。

OBJECTIVE To comparatively analyze the clinical distribution,drug susceptibility and capacity of biological membrane production of Candida albicans infection,so as to provide a scientific basis for antifungal agents use in a rational way in clinic.METHODS A total of 7612 strains of fungi were isolated and collected from the patients＇ samples in the hospital from Jan.2013 to Aug.2015.The bacteria were isolated and cultured according to the national clinical laboratory operation rules,using VITEK-2Compact analyzer to identify species,using paper K-B to give the test of drug sensitivity in vitro,using WHONET 5.6software for statistical analysis,and crystal violet staining method for quantitative analysis of C.albicans biological membrane.RESULTS A total of 1366 strains of C.albicans were isolated,accounting for 17.9%;C.albicans was mainly isolated from pneumology department（389strains）and emergency department（241strains）,accounting for 28.5% and 17.6% respectively;C.albicans samples were mainly from sputum（68.3%）,followed by urine（10.5%）and secretion（5.8%）.The drug sensitive rate of C.albicans to amphotericin B,voriconazole,fluconazole,flucytosine and itraconazole were respectively 100.0%,100.0%,99.9%,99.8% and 98.0%;standard strain SC5314 was high production of biological membrane and among the 1366 strains of C.albicans,325 strains of low production biological membrane,243 strains of production biological membrane and 798 strains of high production biological membrane were isolated in clinic.CONCLUSION C.albicans has high sensitivity to amphotericin B,voriconazole,fluconazole,flucytosine and itraconazole.In view of the difference clinical distribution of C.albicans,antifungal drugs should be chosen reasonably in clinical treatment.At the same time the enhancement of monitoring fungal resistance can help to reduce the generation of drug-resistant strains,promoting the study of relation between biological membrane produce ability and the resistance mechanism of C.albicans.