肝病患者无菌部位酵母菌感染的临床特征及抗真菌药物的敏感性分析

Clinical distribution of yeast infection in aseptic parts of patients with liver disease and sensitivity analysis of antifungal drugs

目的侵袭性酵母菌感染与重症监护室和器官移植等免疫力低下患者的感染率密切相关,本研究分析了酵母菌感染无菌部位的临床分布特征,同时对7种抗真菌药物的体外抑菌活性进行了分析。方法对来自解放军302医院2012年至2017年间无菌部位分离的188株酵母菌,采用微量肉汤稀释法测定酵母菌对常用抗真菌药的最低抑菌浓度(minimum inhibitory concentration,MIC);分析188株酵母菌的临床分布特征。结果白念珠菌(45.7%)是导致肝病患者无菌部位感染的主要酵母菌,其次是热带念珠菌(18.1%)和光滑念珠菌(16.0%),分离标本以腹水(39.9%)为主;患者年龄主要集中在50~65岁(43.6%)之间,并且以男性(70.7%)为主,光滑念珠菌是导致50~65岁年龄阶段感染的主要非白念珠菌;药物敏感性试验显示伊曲康唑对白念珠菌的MIC 50的值为0.25μg/mL而MIC 90的值达到了0.5μg/mL,同时卡泊芬净对克柔念珠菌的MIC 50的值为0.25μg/mL而MIC 90的值达到了0.5μg/mL,因此,除了白念珠菌对伊曲康唑的体外敏感性较低(19.8%)和克柔念珠菌对卡泊芬净的体外感性较低(33.3%)外,其他三唑类药物、棘白菌素类药物和5-氟胞嘧啶对酵母菌均有很高的体外抑菌活性。结论白念珠菌仍然是导致肝病患者侵袭性酵母菌感染的主要菌种,感染患者以老年男性为主,抗真菌药物对白念珠菌和非白念珠菌的体外抑菌活性不同,临床应合理选择抗真菌药物。

Objective Invasive yeast infection is closely related to the infection rate of patients with low immunity such as intensive care unit and organ transplantation.This study analyzed the clinical distribution characteristics of yeast infection in the sterile site,and analyzed the in vitro antifungal activity of seven drugs.Methods The minimum inhibitory concentration(MIC)of 188 yeast strains collected from the 302th hospital of PLA from 2012 to 2017 was determined.The clinical distribution characteristics of 188 yeasts were analyzed.Results Candida albicans(45.7%)is the main yeast causing infection in the aseptic site of patients with liver disease,followed by Candida tropicalis(18.1%)and Candida glabrata(16.0%),and the infected site is mainly ascites fluid(39.9%);Mainly between 50 and 65 years old(43.6%),and mainly patients were male(70.7%).Candida glabrata is the mainly non-Candida albican that causes infection in the age of 50-65 years;drug sensitivity test demonstrated that the MIC 50 of itraconazole against Candida albicans was 0.25μg/mL and MIC 90 was 0.5μg/mL,while the MIC 50 of caspofungin to Candida krusei was 0.25μg/mL while MIC 90 reached at 0.5μg/mL except for Candida albicans on itraconazole the sensitivity is low(19.8%)and the sensitivity of Candida krusei to the caspofungin is low(33.3%),triazole drugs,echinocanins and 5-fluorocytosine have high in vitro antifungal activity against yeast.Conclusion Candida albicans was still the main strain of invasive yeast infection.The infected patients are mainly male.The antifungal drugs have different antifungal activities against Candida albicans and non-Candida albicans.The antifungal drugs should be selected reasonably.