昆明地区2型糖尿病老年住院患者口腔真菌定植危险因素及药敏研究

Risk factors and drug sensitivity of oral fungal colonization in elderly inpatients with type Ⅱ diabetes in Kunming

目的研究2型糖尿病老年住院患者真菌定植及分布情况,分析真菌定植的高危因素及药敏情况,指导真菌感染的防治。方法采用口腔黏膜拭子法,对88例2型糖尿病老年住院患者进行取材,采用CHROMagar念珠菌显色培养基及API 20C AUX酵母菌鉴定系统对念珠菌进行培养、分离、纯化和鉴定。采用肉汤微量稀释法进行抗真菌药物敏感性试验。结果2型糖尿病老年住院患者88例中,检出口腔真菌定植有48例,其定植真菌菌种鉴定结果为,白念珠菌占87.5%,近平滑假丝酵母菌占8.3%,酿酒酵母菌占4.2%;检出真菌定植的患者中,与2型糖尿病患者口腔真菌定植相关的危险因素主要为是否合并其他疾病(P<0.05),单一2型糖尿病组与合并其他疾病组定植率存在显著性差异;白念株菌对伊曲康唑耐药率19%,氟康唑和伏立康唑为14.3%。结论2型糖尿病老年住院患者真菌定植问题普遍存在,其最常见的口腔定植真菌是白念珠菌,主要危险因素是合并其他疾病,尤其是否合并有肺部相关疾病史,其敏感药物为两性霉素B,对伊曲康唑、氟康唑和伏立康唑有一定耐药性。

Objective To study the colonization and distribution of fungi in hospitalized elderly patients with type 2 diabetes mellitus,analysis of the risk factors and drug resistance of fungal colonization,to guide the prevention and treatment of fungal infections.Methods A total of 88 elderly inpatients with type 2 diabetes mellitus were drewed samples by oral mucosal swab method.The culture,isolation,purification and identification of Candida were carried out using CHROMagar Candida chromogenic medium and API 20C AUX yeast identification system.The antifungal drug sensitivity test was carried out using a broth microdilution method.Results Among the 88 elderly inpatients with type 2 diabetes mellitus,48 cases of oral fungal colonization were detected,and the results of identification of the colonized fungal strains were 87.5%of Candida albicans,8.3%of Candida parapsilosis,and Saccharomyces cerevisiae.4.2%;among the patients with fungal colonization,the risk factors associated with oral fungal colonization in patients with type 2 diabetes mellitus were mainly other combined with other diseases(p<0.05),and the colonization rate of single type 2 diabetes group and other disease groups was significant.The resistance rate of Candida albicans to itraconazole was 19%,and that of fluconazole and voriconazole was 14.3%.Conclusion C.albicans is the most common fungus in elderly inpatients with type 2 diabetes mellitus.Accompanying with other diseases is the high risk factors of oral fungal colonization in elderly inpatients with type 2 diabetes mellitus.The fungi in the group of elderly inpatients with type 2 diabetes mellitus are sensitive to amphotericin.