深部酵母菌感染分布及耐药性分析

Distribution and drug resistance of deeper infection caused by yeasts

目的了解深部酵母菌的感染分布特征及对常见抗真菌药物的耐药性,为临床合理使用抗真菌药物和有效控制院内感染的发生提供参考依据。方法收集同济医院2010-2015年临床分离的764株深部感染的酵母菌,研究不同酵母菌菌种感染部位的分布规律,并使用酵母菌药敏试验试剂盒ATB-fungus 3检测764株酵母菌对常用抗真菌药物的耐药性。结果 764株酵母菌中以白色念珠菌为主,占47.0%。764株酵母菌主要分离自血液标本184株(24.1%),腹水标本151株(19.8%)和纤支镜冲洗液标本146株(19.1%);764株酵母菌对氟康唑、伊曲康唑、两性霉素B、5-氟胞嘧啶和伏立康唑的敏感率分别为91.3%、73.4%、96.6%、97.7%和95.4%;白色念珠菌、热带念珠菌、近平滑念珠菌和新型隐球菌对5种抗真菌药物的耐药率均低于10%。结论深部感染酵母菌中白色念珠菌的分离率最高。酵母菌对氟康唑、伏立康唑、5-氟胞嘧啶和两性霉素B的敏感率较高,对伊曲康唑的敏感率较低。白色念珠菌、热带念珠菌、近平滑念珠菌和新型隐球菌对3种唑类抗真菌药物较为敏感。

Objective To investigate distribution and drug resistance of deeper infection caused by yeasts,and to provide reference of using antifungal drugs in clinical and control of nosocomial infection.Methods A total of 764 strains of yeasts were isolated from Tongji Hospital during 2010-2015 and infected distributions of the pathogens were investigated.ATB FUNGUS 3 kit was used to detect drug resistance of the 764 strains of yeasts which was commonly used.Results The number of strains of yeasts which isolated from blood,abdominal dropsy and bronchoscopy lavage were 184 （24.1%）,151 （19.8%） and 146 （19.1%） respectively.The sensitivity of 764 yeast strains to fluconazole,amphotericin B,itraconazole,5-fluorocytosine and voriconazole were 91.3%,73.4%,96.6%,97.7% and 95.4%,respectively.The resistance rates of Candida albicans,Candida tropicalis,Candida parapsilosis and Cryptococcus neoformans to five kinds of antifungal agents were all below 10%.Conclusion Deeper infection caused by Candida albicans is the most common.The sensitivity of yeasts in vitro susceptibility test to fluconazole,voriconazole,5-fluorocytosine and amphotericin B are higher,but lower to itraconazole.Candida albicans,Candida tropicalis,Candida parapsilosis and Cryptococcus neoformans are sensitive to triazole antifungal drugs.