北京某医院侵袭性念珠菌感染的菌株分布及药敏分析

Species distribution and antifungal susceptibility test of invasive Candida infection in a hospital in Beijing

目的调查北京某医院侵袭性念珠菌感染的菌株分布和药敏特点,为临床合理使用抗真菌药物提供依据。方法收集该医院4年间(2012—2013年,2016—2017年)临床分离的126株侵袭性念珠菌菌株,对菌种构成进行分析,采用微量肉汤稀释法对7种抗真菌药物进行药敏分析。结果126株念珠菌中,白念珠菌比例最高,占38.10%,非白念株菌以光滑念珠菌比例最高(30.95%),其次为热带念珠菌(18.25%)和近平滑念珠菌(11.11%)。白念珠菌和近平滑念珠菌对两性霉素B、唑类和棘白菌素类药物的敏感率(野生型率)接近100%。而光滑念珠菌和热带念珠菌对氟康唑(10.26%和30.43%)和伏立康唑(48.72%和26.09%)均表现出较高的耐药率(非野生型率),但对两性霉素B和棘白菌素类药物的敏感率(野生型率)>92%。结论我院侵袭性念珠菌感染中,非白念珠菌的分离率已高达61.90%。两性霉素B和棘白菌素类可用于侵袭性念珠菌感染的经验治疗,对光滑念珠菌和热带念珠菌引起的感染应谨慎使用唑类药物。

Objective To investigate the species distribution and antifungal susceptibility of invasive candida infection in a hospital in Beijing,and to provide evidence for rational use of antifungal drugs.Methods Totally 126 strains of invasive candida isolates were collected from the hospital during 2012—2013 and 2016—2017,and the composition of the strains were analyzed.The susceptibility of 7 antifungal drugs was analyzed by microbroth dilution method.Results Of the 126 Candida strains,C.albicans was the most predominant,accounting for 38.10%.Of the non-C.albicans strains,C.glabrata was the most common with a frequency of 30.95%,followed by C.tropicalis(18.25%)and C.parapsilosis(11.11%),respectively.The susceptibility(wild type)rates of C.albicans and C.parapsilosis to amphotericin B and echinomycins were close to 100%.The resistance(non wild type)rates of C.glabrata and C.tropicalis to fluconazole(10.26%and 30.43%)and voriconazole(48.72%and 26.09%)were showed in higher levels,while the susceptibility(wild type)rates of C.glabrata and C.tropicalis to amphotericin B and echinomycins were>92%.Conclusion The frequency of non-C.albicans in invasive Candida infection was up to 61.90%.Amphotericin B and echinomycins could be used for the empirical treatment of invasive Candida infection,while azoles should be used with caution for C.glabrata and C.tropicalis infections.