中国1 200株外阴阴道假丝酵母菌病致病菌对5种常用抗真菌药物的耐药性和敏感性分析

Analysis of resistance and sensitivity of 1200 strains of vulvovaginal candidiasis in China to five common antifungal drugs

目的了解中国外阴阴道假丝酵母菌病致病菌对目前临床常用的抗真菌药物的敏感性。方法本研究纳入我国23家医院妇科和计划生育门诊就诊的1200例外阴阴道假丝酵母菌病患者,采集患者的阴道分泌物进行假丝酵母菌菌株分离和菌株鉴定,参照美国临床实验室标准研究所(CLSI)M27-S3方案,测定1200株菌株对克霉唑、氟康唑、咪康唑、伊曲康唑及制霉菌素5种常用抗真菌药物的敏感性和耐药性情况。结果(1)1200株外阴阴道假丝酵母菌病致病菌对5种抗真菌药物的敏感性和耐药性不同,各药物比较有明显差异(χ^(2)=3513.201,P<0.01)。(2)所有菌株对制霉菌素敏感性更高[敏感率为99.92%(1199/1200)],其次是咪康唑[敏感率为92.25%(1107/1200)]和克霉唑[敏感率87.17%(1046/1200)],所有菌株对氟康唑的耐药性最高[耐药率为69.17%(830/1200)],而对伊曲康唑的耐药性次之[耐药率为50.83%(610/1200)]。(3)白假丝酵母菌和非白假丝酵母菌对制霉菌素的敏感性均很高且无差异(P=0.425),对咪康唑的敏感性也较高且无差异(P=0.315)。(4)白假丝酵母菌和非白假丝酵母菌对克霉唑、氟康唑和伊曲康唑的敏感性均不同,相比于非白假丝酵母菌,白假丝酵母菌对克霉唑的敏感性更高[敏感率分别为73.01%(165/226)、90.45%(881/974),P<0.001],对氟康唑的耐药性更高[耐药率分别为50.88%(115/226)、73.41%(715/974),P<0.001]。虽然对伊曲康唑的敏感性不高,但是白假丝酵母菌比非白假丝酵母菌对伊曲康唑的敏感率高[分别为37.68%(367/974)、23.89%(54/226),P<0.001],耐药率低[分别为49.28%(480/974)、57.52%(130/226),P<0.001]。结论1200株假丝酵母菌对5种常用抗真菌药物的敏感性具有明显差异,对制霉菌素、咪康唑和克霉唑的敏感性较高,而对氟康唑和伊曲康唑的耐药性较高。白假丝酵母菌和非白假丝酵母菌对不同抗真菌药物的敏感性和耐药性存在很大差异,临床上应重视对假丝酵母菌的鉴定和药物敏感性试验,合理选用抗真菌药物。

Objective To test the antibiotic susceptibility of vulvovaginal candidiasis pathogenic strains to 5 antifungal drugs commonly used in clinic.Methods A total of 1200 vulvovaginal candida patients from 23 gynecological and family planning outpatient departments in China were enrolled.Their vaginal secretions were collected for candida strain isolation and species identification.According to Clinical and Laboratory Standards Institute(CLSI)M27-S3,the sensitivity of 1200 strains to clotrimazole,fluconazole,miconazole,itraconazole and nystatin was tested.Results(1)The sensitivity and resistance of 1200 vulvovaginal candidiasis pathogens to 5 antifungal drugs were statistically different(χ^(2)=3513.201,P<0.01).(2)All strains had higher sensitivity to nystatin[99.92%(1199/1200)],followed by miconazole[92.25%(1107/1200)]and clotrimazole[87.17%(1046/1200)].All strains had higher resistance to fluconazole[69.17%(830/1200)],while itraconazole was 50.83%(610/1200).(3)There was no significant difference between candida albicans and non-candida albicans in drug sensitivity to nystatin(P=0.315)and miconazole(P=0.425).(4)Candida albicans and non-candida albicans showed different sensitivity to clotrimazole,fluconazole and itraconazole,respectively.Compared with non-candida albicans,candida albicans showed higher sensitivity to clotrimazole[susceptibility rate:73.01%(165/226)vs 90.45%(881/974);P<0.001]and higher resistance to fluconazole[resistance rate:50.88%(115/226)vs 73.41%(715/974);P<0.001].Although the drug sensitivity of itraconazole was not high,the susceptibility rate of candida albicans to itraconazole was slightly higher than that of non-candida albicans[37.68%(367/974)vs 23.89%(54/226)],and the drug resistance rate was lower[49.28%(480/974)vs 57.52%(130/226)].Conclusions The sensitivity of 1200 strains of candida to 5 antifungal drugs is significantly different,the sensitivity rate of nystatin,miconazole and clotrimazole are higher,but the resistance rate of fluconazole and itraconazole are higher.The sensitivity of candida albicans and non-candida albicans to the same drug is also significantly different.It is suggested that in clinical diagnosis and treatment,we should pay attention to the identification of candida and drug sensitivity test,so as to select antifungal drugs rationally.