血培养分离出212株念珠菌的菌种分布及耐药性分析

The distribution and drug resistance of 212 Candida isolates from blood culture

目的分析血培养分离出的念珠菌的菌种分布及耐药分析,为临床念珠菌血症的诊治提供理论依据。方法回顾性分析2017年1月—2020年12月期间,本院血培养分离出的念珠菌的菌种分布、药敏试验结果及患者血培养分离出念珠菌前后96 h内的G试验结果。结果血培养中分离出念珠菌314例,阳性率2.1%,其中非重复分离株212例。检出率最高的是近平滑念珠菌(72株,34.0%),其次是白念珠菌(55株,25.9%)和光滑念珠菌(28株,13.2%)。念珠菌检出率最高的科室为ICU(62株,29.2%),其次是新生儿科(39株,18.4%)和血液科(20株,9.4%)。检出的212株念珠菌除一株近平滑念珠菌为两性霉素B的非野生株,其余均为两性霉素B的野生株。白念珠菌对唑类药物的敏感率超过90%。但光滑念珠菌和热带念珠菌对唑类药物的敏感性较低。血培养分离出念珠菌的前后96 h内,G试验的阳性率为73.7%。结论本院念珠菌检出率前3位分别是近平滑念珠菌、白念珠菌和光滑念珠菌。光滑念珠菌、热带念珠菌对唑类药物敏感性比较低,在经验用药时需要合理选择抗真菌药物。G试验对念珠菌血症有较高的价值,需要对结果进行动态监测。

Objective To investigate the clinical distribution characteristics and drug resistance of Candida infection in bloodsteam,and provide basis for clinical diagnosis and treatment.Methods A retrospective analysis was carried out to analysis the Candida isolates from clinical blood from January 2017 to December 2020.Pathogen distribution,antibiotic resistance and the results of G test of the Candida infection were analyzed.Results In blood culture,314 cases of Candida strains were incubated with a positive rate of 2.1%and 212 cases of non-repetitive isolates were isolated.Candida parapsilosis(72 strains,34.0%)had the highest detection rate,followed by Candida albicans(55 strains,25.9%)and Candida glabrata(28 strains,13.2%).These patients mainly came from the department of ICU(62 strains,29.2%),department of neonatology(39 strains,18.4%)and department of hematology(20 strains,9.4%).Except of a strain of Candida parapsilosis,other Candida strains were wild strains of amphotericin B.The sensitivity rate of Candida albicans to azole drugs was over 90%.However,Candida parapsilosis and Candida tropicalis were less sensitive to azoles.Within 96 hours before or after the isolation of Candida from blood culture,the positive rate of G test was 73.7%.Conclusion The top three isolates in our hospital were Candida parapsilosis,Candida albicans and Candida glabrata.Candida glabrata and Candida tropicalis are less sensitive to azoles,so it was necessary to select antifungal drugs reasonably.G test was of high value in the treatment of candidiasis and the results need to be monitored dynamically.