497例临床假丝酵母菌菌种分布及耐药性分析

Analysis of distribution and drug resistance of clinical Candida strains in 497 cases

目的了解沈阳地区住院患者标本中分离出假丝酵母菌感染的类型、分布及耐药情况,为指导临床预防假丝酵母菌感染及合理用药提供理论依据。方法回顾性收集中国医科大学附属盛京医院2015~2018年住院患者送检标本中分离出假丝酵母菌菌株的临床资料,统计菌株鉴定及药敏实验数据及结果。结果共检出假丝酵母菌497株,其中以近平滑假丝酵母菌为主(175,35.2%),其次依次为白假丝酵母菌(127,25.6%)、菌膜假丝酵母菌(51,10.3%)、光滑假丝酵母菌(42,8.5%)和热带假丝酵母菌(36,7.2%),菌种分布存在统计学差异(P=0.004);菌株宿主主要来源于0~9岁及50~69岁年龄段患者;检出标本来源以血液标本最多(405,81.5%),胸腹水(21,4.2%)和引流液(21,4.2%)次之,不同标本类型之间菌株分布有统计学差异(P=0.003);临床常见假丝酵母菌对氟康唑(FLU)、伏立康唑(VRC)、氟胞嘧啶(FC)、伊曲康唑(ITR)和两性霉素B(Amb)的耐药率分别为3.0%、2.2%、4.0%、5.0%和4.0%。结论院内假丝酵母菌感染以近平滑假丝酵母菌最为常见。在治疗新生儿、老年患者和消化系统疾病患者,要警惕发生假丝酵母菌的二重感染。

Objective To explore the type,distribution and drug resistance of inpatient’s Candida infection in Shenyang,so as to provide theoretical basis for clinical prevention and rational drug use of Candida infection.Methods The clinical data of Candida strains isolated from inpatients in Sheng Jing Hospital affiliated to China Medical University from 2015 to 2018 were collected retrospectively,and the data and results of strain identification and drug sensitivity test were statistically analyzed.Results A total of 497 strains of Candida were detected,of which the main strains were Candida parapsilosis(175,35.2%),followed by Candida albicans(127,25.6%),Candida pelliculosa(51,10.3%),Candida glabrata(42,8.5%)and Candida tropicalis(36,7.2%).The distribution of the strains was statistically different(P=0.004).The hosts were mainly of patients aged 0-9 and 50-69 years old.In 497 strains of Candida,the isolates of from blood was accounted for 81.5%,followed by those from hydrothorax or ascitic fluid(4.2%),drainage fluid(4.2%)cerebrospinal fluid(1.4%)and urine were(1.4%).There was significant difference in the distribution of strains among different types of samples(P=0.003).The resistance rates of clinical common Candida to fluconazole,voriconazole,flucytosine,itraconazole,and amphotericin B were 3.0%,2.2%,4.0%,5.0%and 4.0%,respectively.Conclusion The infection of Candida albicans in hospital was the most common.In the treatment of newborns,elderly patients and patients with digestive system diseases,we should be alert to the occurrence of double infection of Candida.