热带假丝酵母菌感染临床检验调查

目的对热带假丝酵母菌感染的临床分布、治疗状况及对抗真菌药物的敏感情况进行分析。方法采用回顾性调查方法分析2013年7月至2016年7月收治的血培养“热带假丝酵母菌”阳性病例共47例的临床资料。结果患者中男31例，女16例，中位年龄51岁；血液内科24例，重症监护12例，急诊、呼吸、消化和胃肠外科等总共11例。生化特性鉴定显示，与白色假丝酵母菌相比分离菌株蛋白酶活性较低，脂肪酶无显著差异，而葡糖苷酶活性较高。抗真菌药物敏感性检测显示，所有真菌均对5-氟胞嘧啶、两性霉素B敏感，氟康唑敏感63．8％（30／47），伊曲康唑敏感59．6％（28／47），伏立康唑敏感68．1％（32／48）。治疗后，23例患者预后良好（49．0％），24例患者死亡（51．0％）。主要死亡原因为感染性休克和多脏器功能衰竭。结论热带假丝酵母菌致病性强，感染人群年龄分布广。目前应用的卡泊芬净针和广谱抗真菌药物5-氟胞嘧啶和两性霉素B对其具有一定治疗效果。感染热带假丝酵母菌的患者病死率较高，因此应对该菌属感染引起重视．加强对其进行耐药性监测，以指导临床合理使用抗菌药物。

Objective To investigate the clinical distribution, treatment efficiency and antifungal sensitivity of tropical and subtropical Candida infections. Methods A total of 47 clinical cases of tropical and subtropical Candida infection were collected consecutively in the first hospital of Wenzbou University from July 2013 to July 2016, and were analyzed by retrospective method. All isolates were identified to the species level by the VITEK2 automated identification system and VITEK2 YST identification cards. Their protease, lipase and glucosidase activity were identified by biochemical tests. In vitro antifungal susceptibility testing of Candida was performed by ATBT MFUNGUS 3 Fungal Susceptibility strips. In addition, the patients were treated with a combination of capufen or capafen with amphotericin B, and the prognosis was analyzed. Results There were 31 cases for men, 16 cases for women and the median age was 51, which including 24 cases in the blood department, 12 cases in intensive care arid 11 cases in emergency care, breathing, digestion and gastrointestinal surgery. Biochemical characterization showed that the isolated strain protease activity was lower, and lipase was no difference and glucosidase activity was higher when compared to the C.albicans. The results of antifungal drug sensitivity test showed that all Candida were susceptive to 5-flucytosine and amphoteticin B, the fluconazole was 63.8% （ 30/47 ） , the itraconazole was 59.6% （ 28/47 ） , the voriconazole was 68.1% （ 32/48 ） . After treatment, 23 patients had a good prognosis （ 49.0% ） , 24 patients died （ 51.0% ） which were caused by infectious shock and multiple organ failure. Conclusion Tropical candida is highly pathogenic, and has a widespread age population. The current application of the caspofungin and broad-spectrum antifungal drug 5-flucytosine and amphoterycin B has certain therapeutic effects. In order to guide the rational use of antimicrobial drugs, we must pay more attention to the tropical candida infection and strengthen the surveillance of drug resistance, because of high mortality rate.