内蒙古某医院2012—2021年念珠菌的临床分布及耐药变迁分析

Analysis of clinical distribution and drug resistance of Candida in a hospital in Inner Mongolia from 2012 to 2021

目的 分析内蒙古自治区人民医院2012—2021年念珠菌的分布以及耐药情况,为临床管理念珠菌感染提供依据。方法 回顾性分析内蒙古自治区人民医院2012年1月到2021年12月念珠菌的菌株分布和药敏实验结果。结果 共分离出5472株念珠菌。标本主要来源于尿液、痰液、分泌物,分别占41.28%、31.69%和11.22%。临床科室分布主要来自保健病房、呼吸与危重症病房和ICU,分别占27.54%、18.29%和17.71%。主要念珠菌菌种有:白念珠菌、热带念珠菌、光滑念珠菌、近平滑念珠菌、无名念珠菌、克柔念珠菌和葡萄牙念珠菌,占比分别为63.96%、14.33%、5.40%、5.23%、3.42%、1.83%和1.70%。白念珠菌、热带念珠菌、近滑念珠菌、光滑念珠菌、无名念珠菌、克柔念珠菌和葡萄牙念珠菌对5-氟胞嘧啶、两性霉素B、伏立康唑、氟康唑和伊曲康唑5种抗真菌药物耐药率分别为0.14%~3.53%、0.39%~22.41%、0~2.82%、0~12.50%、0.53%~5.88%、1.05%~57.895和0~12.22%。白念珠菌的耐药变迁情况不明显。结论 2012—2021年期间,白念珠菌一直为我院最常见念珠菌,但2020年和2021近两年内白念珠菌的分离比例呈现下降趋势,非白念珠菌呈现升高趋势。本院分离的念珠菌中,热带念珠菌对三唑类抗真菌药物耐药率较高,克柔念珠菌除了对氟康唑天然耐药以外,对5-氟胞嘧啶和伊曲康唑的耐药率最高,其余念珠菌对抗真菌药物耐药率均较低。

Objective To analyze the distribution and drug resistance of Candida in a hospital in Inner Mongolia from 2012 to 2021,so as to provide evidence for clinical management of Candida infection.Methods The distribution and drug susceptibility test results of Candida strains in a hospital from January 2012 to December 2021 were retrospectively analyzed.Results A total of 5472 strains of Candida were isolated.The samples were mainly from urine,sputum and secretions,accounting for 41.28%,31.69%and 11.22%,respectively.The distribution of clinical departments was mainly from health ward,respiratory and critical care ward and ICU,accounting for 27.54%,18.29%and 17.71%,respectively.The drug resistance rates of Candida albicans,C.tropicalis,C.paracalbicans,C.glabrata,C.nameless,C.krondo and C.Portugal to 5-flucytosine,amphotericin B,voriconazole,fluconazole and itraconazole were 0.14%-3.53%,0.39%-22.41%,0-2.82%,0-12.5%,0%,0.53%-5.88%,1.05%-57.895%and 0-12.22%respectively.The change of drug resistance of C.albicans was not obvious.Conclusions C.albicans had been the most common candida in our hospital from 2012 to 2021,but the proportion of C.albicans isolated in 2020 and 2021 showed a downward trend,while non-Candida albicans showed an upward trend.Among C.tropicalis isolated in our hospital,the resistance rate to triazole antifungal drugs was high in C.tropicalis,and the resistance rates to 5-flucytosine and itraconazole were the highest in C.kronoris except for the natural resistance to fluconazole,while the resistance rates of other Candida strains were low.