外阴阴道念珠菌病病原谱及抗真菌药物敏感性特征

Candida spectrum and characteristics of antifungal susceptibility in vulvovaginal candidiasis

目的了解嘉定区妇女外阴阴道念珠菌病（VVC）患者的年龄、菌群分布以及病原真菌对体外抗真菌药物的敏感性,为VVC的临床诊疗提供依据。方法采集2015年7至10月嘉定区妇幼保健院VVC患者阴道后穹隆分泌物样本,采用科玛嘉念珠菌显色培养基结合ATB微生物鉴定系统进行培养和初步鉴定,所有菌株均采用真菌内转录间隔区（ITS）1、ITS4测序鉴定。用Sensititre Yeast One真菌药物敏感性鉴定系统进行药物敏感性试验,测定最低抑菌浓度（MIC）,依据美国临床实验室标准化协会（CLSI）2012 M27-S4标准判读MIC结果。结果共分离出829株念珠菌,复发组82株。发病年龄以成年妇女（20~59岁）为主（占97.1%）。在分离的菌株中,白念珠菌占77.1%（639/829）,光滑念珠菌占15.1%（125/829）,近平滑念珠菌占3.4%（28/829）,热带念珠菌占2.1%（17/829）,克柔念珠菌占1.6%（13/829）,酿酒酵母占0.8%（7/829）。非复发VVC患者和复发VVC（RVVC）患者分离的白念珠菌对氟康唑、伊曲康唑、伏立康唑、氟胞嘧啶、卡泊芬净、阿尼芬净、米卡芬净的敏感率分别是66.1%、41.5%,81.4%、53.7%,44.1%、26.8%,96.6%、95.1%,100.0%、100.0%,100.0%、100.0%,100.0%、100.0%。结论白念珠菌是VVC的主要病原菌,对唑类药物耐药率较高。VVC患者应当根据药物敏感性试验结果合理选择抗真菌药物进行精准治疗,以减少耐药菌株的产生。

ObjectiveTo investigate the age,Candida distribution and in vitro antifungal susceptibility in patients with vulvovaginal candidiasis（VVC）in Jiading district,and to provide a reference for the diagnosis and treatment of VVC. MethodsThe vaginal secretions from patients with VVC in the Maternal and Children Healthcare Hospital of Jiading District from July 2015 to October 2015 were collected,and Candida were cultured and identifled by CHROMagar Candida color medium and ATB microbiological identiflcation system. All isolates were conflrmed by sequencing,using internal transcribed spacer（ITS）1 and ITS4. Drug susceptibility test was performed by Sensititre Yeast One,and minimal inhibitory concentration（MIC） was determined according to the Clinical and Laboratory Standards Institute（CLSI）2012 M27-S4. ResultsA total of 829 isolates of Candida were isolated,and 82 isolates were collected from recurrent vulvovaginal candidiasis（RVVC） group. Adult women（20-59 years old） accounted for 97.1%. Candida albicans accounted for 77.1%（639/829）,Candida glabrata accounted for 15.1%（125/829）,Candida parapsilosis accounted for 3.4%（28/829）,Candida tropicalis accounted for 2.1%（17/829）,Candida krusei accounted for 1.6%（13/829）,and Saccharomyces cerevisiae accounted for 0.8%（7/829）. The susceptibility rates of Candida albicans in VVC group to fluconazole,itraconazole,voriconazole,flucytosine,caspofungin,anidulafungin and micafungin were 66.1%,81.4%,44.1%,96.6%,100.0%,100.0% and 100.0%,and those in RVVC group were 41.5%,53.7%,26.8%,95.1%,100.0%,100.0% and 100.0%,respectively. ConclusionsCandida albicans is the main pathogenic fungus for VVC,and the drug resistance rate to azoles is high. Therefore,antifungal agents should be chosen according to the results of drug susceptibility test to improve the precision of treatment and reduce the incidence of drug resistant isolates.