皮肤科住院患者口腔念珠菌感染的病原学及相关因素

Etiology and risk factor analysis of oral candidiasis from in-patients of dermatological department

目的:通过分析皮肤科住院患者口腔定植念珠菌的菌种分布情况,研究其定植的高危因素,评估体外药敏情况及耐药率,为皮肤科患者出现念珠菌感染的预防和治疗提供理论依据。方法:采用整群抽样,口腔黏膜拭子法取材,通过念珠菌显色培养基和API 20C AUX酵母菌鉴定系统做菌种鉴定,采用肉汤微量稀释法开展酵母菌药物敏感性试验,结合临床资料,分析念珠菌定植的高危因素。结果:586例患者中口腔念珠菌定植率为40.4%,其中白念珠菌最为常见(占83.1%),感染性皮肤病、结缔组织病、疱病及系统使用抗生素是口腔真菌定植的高危因素,体外药敏试验结果显示,248株真菌对伊曲康唑的耐药率最高(为8.5%),其次是氟康唑(为4.4%)和伏立康唑(为1.2%),对两性霉素均敏感。结论:皮肤科住院患者口腔念珠菌定植率高,白念珠菌菌株对唑类抗真菌药物的耐药率较低,但非白念珠菌对唑类抗真菌药物的耐药率相对较高,治疗前宜行药敏试验。

Objective:To determinie the distribution of species among in-patients of dermatological department,investigate the risk factors associated with oral candidiasis and evaluate antifungal susceptibility profile of oral candida.To provide a theoretical basis of candida infection and prevention.Methods:Cluster sampling method was adopted in our study.Mucosal swab samplings were taken from the objects.The strains were identified by CHROMagar Candida agar medium,and API20C AUX system for yeasts.Antifungal susceptibility was tested in vitro by the broth microdilution method.The risk factors was investigated by analysis of clinical data.Results:Oral candida carriage rate was40.4%in in-patients of dermatological department.C.albicans accounted for83.1%of the candida species.Infectious skin diseases,connective tissue disease,blister disease and use of antibiotics were risk factors associated with oral candidiasis.The percentage of resistant to itraconazole,?uconazole and voriconazole were8.5%,4.4%and1.2%.All of the isolates were susceptible to amphotericin B.Conclusion:The oral candida colonization rate in in-patients of dermatological department is high.The percentage of resistant to C.albicans is low,but high azole-resistance rate is found among non-C.albicans fungal species.In vitro antifungal susceptibility is necessary before antifungal therapy.