2015—2019年连云港市第二人民医院感染真菌患者菌株分布及耐药性分析

目的 分析2015—2019年连云港市第二人民医院真菌培养阳性标本的病原菌分布情况和耐药状况。方法 收集2015年1月—2019年12月在连云港市第二人民医院所有的真菌培养和药敏试验阳性的标本共663例,应用DL-96Ⅱ细菌测定系统的体外诊断试剂DL-96FOUNGUS对样本进行真菌鉴定,以5种常见抗真菌药物为例,采用MIC法开展对样本中已鉴定真菌的药物敏感性试验,并应用WHONET 5.6软件进行对于该试验结果的统计学分析。结果 2015—2019年连云港市第二人民医院共分离出真菌663株。按照菌种类型分类,可得到如下比例：白色假丝酵母菌占49.9%（331/663）、热带假丝酵母菌占15.2%（101/663）、都柏林假丝酵母菌占8.3%（55/663）、光滑假丝酵母菌14.9%（99/663）、其他假丝酵母菌占11.6%（77/663）。白色假丝酵母菌对伏立康唑、氟康唑、伊曲康唑3种抗菌药物仍具有耐药性;热带假丝酵母菌对氟胞嘧啶、两性霉素高度敏感,对伏立康唑、氟康唑、伊曲康唑表现为耐药;光滑假丝酵母菌对氟胞嘧啶和两性霉素B的敏感性最高。结论 白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌是真菌感染的主要常见致病菌,以热带假丝酵母菌为主的多种假丝酵母菌对于氟康唑、伊曲康唑等临床常用抗菌药物耐药性日渐增长。     

恶性肿瘤患者医院深部真菌感染及耐药情况分析

目的 探讨我院恶性肿瘤病房深部真菌感染的菌株分布及其耐药特点,为临床合理选用抗真菌药物提供依据.方法 对2003年1月～2006年12月入院的恶性肿瘤患者1518例,根据临床需要,采集不同部位的标本进行真菌培养和药敏试验.结果 共检出598株菌株,总检出率39.4%,其中首位为白假丝酵母菌65.1%,其次热带假丝酵母菌13.4%.常见感染部位为呼吸道(58.7%),泌尿道(28.1%),分离的菌株对5-氟胞嘧啶、两性霉素B的耐药性低,对氟康唑、伊曲康唑的耐药性较高.结论 白假丝酵母菌仍然是引起恶性肿瘤病房深部真菌感染的主要病原,5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑对其也有较高的抗菌活性.但非白假丝酵母菌引起的深部真菌感染有上升趋势,对氟康唑、伊曲康唑具有相当高的耐药性,应引起临床重视.     

深部病原性真菌感染及耐药性分析

目的:探讨深部病原性真菌感染的特点及耐药趋势.方法:用回顾调查的方法对我院住院病人及门诊病人各类标本培养的68株病原性真菌对常用抗真菌药物药敏试验结果进行分析.结果:分离出的68株病原真菌以内科系统为主,共52株(占76.47%);检出病原性真菌最多的部位是呼吸道,占真菌标本的64.71%;真菌以白色假丝酵母菌、近平滑假丝酵母菌和类星型念球菌为主,分别占58.82%、8.82%、8.82%;药敏结果,氟胞嘧啶、两性霉素B 90%敏感,白色假丝酵母菌对氟康唑、伊曲康唑、伏立康唑的耐药率很高均在70%以上,5种常见抗真菌药物对其他病原真菌的敏感率均在90%以上.结论:加强临床病原性真菌分离株,对抗真菌药物的耐药性检测,然后根据药敏试验结果科学合理选用抗真菌药物十分重要.     

2018-2022年深圳市妇幼保健院分离真菌的分布及耐药情况分析

目的 调查分析南方医科大学附属深圳妇幼保健院分离真菌的分布特点和药物敏感性情况,为妇幼真菌感染疾病的临床诊治、耐药性监测和流行病学研究提供参考。方法 回顾分析南方医科大学附属深圳妇幼保健院2018年1月-2022年12月标本采集、真菌鉴定和抗真菌药敏试验的结果数据。结果 共分离真菌3 350株,前2位分别为白色念珠菌1 542株、光滑念珠菌223株。阳性标本以阴道分泌物/宫颈分泌物为主。妇科和产科分离到的真菌最多。白色念珠菌对伊曲康唑、伏立康唑的5年耐药率分别为9.58%、4.12%,对两性霉素B和5-氟胞嘧啶的5年敏感率分别为99.79%、98.01%,对氟康唑的历年敏感率有逐渐升高的态势。光滑念珠菌、近平滑念珠菌和热带念珠菌对两性霉素B及5-氟胞嘧啶的敏感率均为100.00%。克柔念珠菌对两性霉素B和伏立康唑100.00%敏感。结论 南方医科大学附属深圳妇幼保健院分离真菌以念珠菌属为主,其中白色念珠菌最多。阴道分泌物/宫颈分泌物是主要真菌阳性分离标本。白色念珠菌对两性霉素B的耐药率最低、敏感率最高,对伊曲康唑的耐药率最高、敏感率最低。光滑念珠菌、近平滑念珠菌、热带念珠菌和克柔念珠菌对两性霉素B和5-氟胞嘧啶均无耐药性。光滑念珠菌对伊曲康唑耐药率最高、敏感率最低。     

重症监护病房真菌感染的病原菌分布与耐药性分析

目的:对重症监护病房(ICU)内真菌感染的常见菌种、感染部位及耐药情况进行分析,为指导临床合理使用抗真菌药提供病原学依据。方法:回顾性调查我院ICU2009-2010年660例患者的病历,对真菌感染种类、菌种的分布及耐药性进行统计分析。结果:660例患者中发生真菌感染98例,占14.8%,以呼吸道感染为主,占50.0%;其次为泌尿道感染,占43.4%。各种感染性标本共分离真菌106株,主要为白色假丝酵母菌(51.9%)、热带假丝酵母菌(34.0%)和光滑假丝酵母菌(9.4%);对氟康唑、伊曲康唑、伏立康唑具有较高的耐药性(耐药率≥47.2%),对两性霉素B、5-氟胞嘧啶、制霉菌素比较敏感(敏感率≥81.8%)。结论:应重视对真菌的培养鉴定和药敏试验,积极开展真菌耐药性监测,密切关注真菌的耐药变迁,合理选择抗真菌药物,防止和延缓菌株耐药性进一步扩大。     

2010年我院就诊妇女生殖道真菌感染药物敏感状况分析

目的为了解成年妇女生殖道真菌感染及药物敏感状况,为临床合理用药提供可靠依据。方法对成年妇女宫颈分泌物进行真菌培养及药敏试验。结果成年妇女生殖道真菌感染白假丝酵母占89.44%,光滑假丝酵母菌占9.68%,克柔假丝酵母菌占0.88%。白假丝酵母菌对7种抗菌药物的敏感率依次为:5-氟胞嘧啶96.07%、氟康唑96.07%、两性霉素B94.75%、益康唑91.15%、制霉菌素90.16%、咪康唑82.95%、伊曲康唑74.75%。结论本地成年妇女生殖道真菌感染以白假丝酵母菌为主,经验用药首选5-氟胞嘧啶和氟康唑。     

2007～2009年酵母样真菌的分离培养及其耐药性分析

目的:探讨引起我院儿童感染酵母样真菌的类型及耐药性,指导临床合理用药.方法:对1 553份住院和门诊儿童的各种标本分离出的203株酵母样真菌,采用科玛嘉念珠显色培养基培养,用API-20CAUX酵母样真菌鉴定试条进行鉴定,用ATB-FUN-GUS进行药敏试验.结果:酵母样真菌203株中白色假丝酵母菌160株(78.81%),近平滑假丝酵母菌15株(7.39%),新型隐球菌7株(3.45%),光滑假丝酵母菌13株(6.40%),热带假丝酵母菌5株(2.46%),克柔假丝酵母菌1株(0.49%),葡萄牙假丝酵母菌2株(0.99%).以呼吸内科、血液科、监护室所占比例较大.203株白色假丝酵母菌对5氟胞嘧啶(5-FC)、两性霉素B(AMB)、氟康唑(FCA)、伊曲康唑(ITR)的敏感率分别为100%、100%、94.38%、80%.结论:致儿童真菌感染的念珠菌仍以白色假丝酵母菌为主,临床用药应依据药敏结果合理用药.     

假丝酵母菌属的耐药性分析

目的 了解我院深部真菌感染的种类和耐药特点,为合理使用抗真菌药物提供病原学依据.方法 对2009-2010年分离的假丝酵母菌属进行菌种分布和耐药性分析.结果 495株假丝酵母菌属占总分离病原菌(3027株)的比例为16.4％,其中白色假丝酵母菌397株,占80.2％;从呼吸道标本中分离出443株,占89.5％;白色假丝酵母菌对两性霉素B、5-氟胞嘧啶、氟康唑、伏立康唑、伊曲康唑的耐药率分别为0.3％ (1/397)、1.5％(6/397)、2.8％ (11/397)、4.8％( 19/397)、10.6％(42/397).结论 白色假丝酵母菌是真菌感染的主要病原菌,早期诊断和合理使用抗真菌药物是防治真菌感染的关键.     

深部真菌的感染特点及耐药分析

目的了解深部真茵感染的临床分布特点及耐药情况,以指导临床合理应用抗真菌药物。方法收集我院临床患者深部的标本(痰液、尿液、粪便、血液、脑脊液、生殖道分泌物、创口分泌物)共426份,接种到沙保弱培养基和显色培养基鉴定菌株。将分纯的菌种接种梅里埃公司生产的ATB Fungus 2真菌药敏板条,用ATB Expression鉴定仪读取最小抑菌浓度(MIC),得出临床常见真菌对抗真菌药物的药敏结果。结果发生深部真菌感染167例,感染真菌标本以痰液检出率最高为63.5%,其次为尿液占15.6%。167株真菌中,假丝酵母菌属感染有160株,其中以白假丝酵母菌为主(67.1%,112/167)。科室分布中,干诊科感染率最高,为41.9%;其次为呼吸科,占26.3%。60岁老年患者有123例,占73.6%。假丝酵母菌属对伏立康唑和伊曲康唑的耐药率较高,分别为75.05%和51.10%,对5-氟胞嘧啶和两性霉素B耐药率较低,分别为2.20%和2.90%。结论老年患者容易患深部真菌感染,感染部位主要为呼吸道,假丝酵母菌属为主要病原菌,其中以白假丝酵母菌感染率最高;两性霉素B、氯康唑和5-氟胞嘧啶耐药率最低,氟立康唑和伊曲康唑的耐药率最高。     

重症监护病房院内肺部真菌感染100例的耐药菌分析

目的:对重症监护病房院内肺部真菌感染100例的病原菌分布和耐药菌进行分析,为临床合理用药提供指导.方法:选取我院于2013年1月～2017年1月收治的100例重症监护病房院内肺部真菌感染患者,对其临床资料进行回顾性分析,对病原菌进行分离和检测,并采用全自动微生物分析仪对病原菌进行药敏试验,分析耐药性.结果:100例患者均对痰液标本进行检测,共分离115株病原菌,主要为白色假丝酵母菌和热带假丝酵母菌;所有病原菌对伊曲康唑和氟康唑的耐药性较低,对氟胞嘧啶、两性霉素B以及伏立康唑的敏感性较高,分别为97.39％、96.52％和93.04％.结论:白色假丝酵母菌和热带假丝酵母菌是导致重症监护病房患者发生院内肺部真菌感染的主要致病菌,从其耐药性分析可以看出,在临床治疗中应首选伏立康唑、氟胞嘧啶以及两性霉素B,有助于提高治疗效果.     

279株临床标本念珠菌药物敏感的分析

目的分析279株临床念珠菌的药物敏感性,以指导临床合理用药治疗真菌感染。方法沙保弱培养基培养标本,用APIAUX20C真菌板条进行鉴定分型,用ATB药敏板条进行药敏实验。结果分离的菌株对两性霉素B敏感率100％、其次是5-氟胞嘧啶除了白色念珠菌敏感率88．2％,其它念珠菌在100％。依曲康唑,氟康唑,依立康唑敏感率很低,都在32％以上。结论两性霉素B、5-氟胞嘧啶为治疗念珠菌感染的首选用药。     

High incidence of antifungal drug resistance in Candida tropicalis

Drug resistance among yeasts is an increasing problem. Isolates of Candida krusei and Candida glabrata are recognized as having reduced susceptibility to fluconazole and resistance to this drug has also arisen in Candida albicans isolated from AIDS patients on long term azole therapy. Candida tropicalis (CT) is being increasingly isolated from human disease and is associated with invasive infection, however, data regarding this organism's drug susceptibility is limited. We report our findings on 60 isolates of CT isolated from patients with serious infection in the North West of England. Over 60% of isolates were from adult Intensive Care Unit (ICU) patients, and almost half were from the respiratory tract. Susceptibility to fluconazole, flucytosine, itraconazole and ketoconazole were tested by standardised methods - 48% of the isolates were resistant to fluconazole (MIC > 12.5 mg/l), and 10% had intermediate susceptibility (MIC 6.25–12.5 mg/l). For flucytosine 17% of isolates were resistant (MIC > 8 mg/l) and 22% had intermediate susceptibility (MIC 2–8 mg/l). Three isolates were resistant to both drugs. For itraconazole 17% of isolates were resistant (MIC > 1 mg/l), and 12% showed intermediate susceptibility (MIC 0.5–1 mg/l). Resistance to ketoconazole was seen in 33% of isolates (MIC > 1 mg/l) and 10% showed intermediate susceptibility (MIC 0.5–1 mg/l). Differences in the degree of cross resistance between the azole drugs was observed. Candida tropicalis should be added to the list of yeasts in which drug resistance is commonly found. Given the high invasiveness of Candida tropicalis, its affinity for patients on ICU and the high incidence of drug resistance in this species, identification and susceptibility tests should be performed on all yeast isolates from patients on ICU.     

Resistance mechanisms in fluconazole-resistant Candida albicans isolates from vaginal candidiasis

Candida albicans is the most frequently identified yeast species causing mycotic vaginitis. A significant number of vaginal yeast isolates are resistant to azole antifungal agents in vitro. Here we investigated the molecular mechanisms of resistance in 22 randomly selected fluconazole-resistant vaginal C. albicans isolates. Twelve isolates in this collection were found to be cross-resistant to itraconazole and 15 to voriconazole. Most of them also displayed decreased susceptibility to terbinafine. Northern blot analyses revealed overexpression of the MDR1 gene in all isolates, which in some isolates was accompanied by elevated levels of CDR1/CDR2 and ERG11 expression. Sequence analysis of the polymerase chain reaction-amplified ERG11 gene of selected azole-resistant isolates identified D116E and V488I amino acid alterations in Erg11p that are known to be conserved in fluconazole-resistant strains. The results demonstrate that decreased susceptibilities of vaginal yeast isolates to clinically used azole derivatives are the result of a combination of several molecular mechanisms involving drug efflux and alterations in the structure or cellular amount of 14-alpha-lanosterol demethylase.     

青柏洁身洗液抑菌实验研究

目的 探讨青柏洁身洗液的体外抗菌作用。方法 以临床妇科常见致病菌为受试菌。采用连续倍比稀释法，观察青柏洁身洗液的最低抑菌浓度和最低杀菌浓度。结果 青柏洁身洗液的MIC和MBC分别为白色念珠菌均为25．0%（ml／m1）。金黄色葡萄球菌3．12％（ml/ml）和12．5％（ml／ml）．铜绿假单孢菌均为50％（ml／ml）。沙门氏菌均为50％（ml／m1）。大肠杆菌均为50%（ml／ml）。结论 青柏洁身洗液对白色念珠菌、金黄色葡萄球菌、沙门氏菌、铜绿假单孢菌、大肠杆菌有一定的抑菌和杀菌作用。     

不同区域女性阴道念珠菌感染分析284例

目的了解阴道念珠菌病患者不同区域女性阴道念珠菌感染及耐药现状。方法通过广汉市第二人民医院妇产科对阴道念珠菌患者采取阴道分泌物余片,经革兰染色镜检菌株,然后进行鉴定及药敏试验。结果本文共鉴定284株念珠菌,其中白色念珠菌检出率占首位87.1%,其次光滑念珠菌检出率11.4%。药敏结果显示,白色念珠菌对5-氟胞嘧啶、衣曲康唑、氟利康唑、制霉素耐药率均<30.5%,较敏感,氟康唑率均>51.3%以上,总耐药率>56.8%以上,敏感性较差。而光滑念珠菌对5-氟胞嘧啶、氟康唑、氟利康唑、衣曲康唑、制霉菌素耐药率均<23.1%,敏感性较好,光滑念珠菌对氟康唑耐药率100%,不敏感。结论白色念珠菌和光滑念珠菌是主要的阴道致病菌,不同种类耐药性有所差异,城市与农村女性的感染率,复发率有差异,应加强病原菌的耐药性检测。     

Susceptibility to miconazole (base) of isolates from the oral cavity and esophagus of patients with mycosis

An antifungal agent of the imidazole class, miconazole (MCZ) (base), was investigated for its in vitro antifungal activities against isolates from the oral cavity and esophagus of patients with mycosis, and the following findings were obtained: 1. Those yeast-like fungi which were presumed to be the causative agents were isolated from the oral cavity and esophagus of patients with mycosis, and identified. Candida albicans was the most frequently occurring species, accounting for 71.4% of all the isolates. Less frequently, several other Candida species, such as Candida krusei, Candida tropicalis, Candida lusitaniae and Candida lipolytica were also isolated mostly from patients with polymicrobial infections. 2. The MICs of MCZ against the isolates of Candida species which were obtained from materials from patients with oral and esophageal candidiasis as the presumable causative agent distributed through such a wide range as less than or equal to 0.04 to 20 micrograms/ml, and susceptibilities of these isolates to MCZ proved to be no less than those to amphotericin B, which was used as the control drug. The results suggest that an appropriate preparation of MCZ (base) will be effective in treating mycosis of the oral cavity and esophagus.     

"Mycelial vaginal test" and Candida susceptibility

We have investigated the possibility of vaginal liquids affecting the transition from a yeast form (Y) to a mycelial one (M) in C. albicans and the possible relation to microbial flora, pH and glycogen. The C. albicans Y----M conversion, "mycelial vaginal test", in 250 specimens of vaginal liquid shows a 70% positivity rate against a test Candida strain. Results of the vaginal test are not related to bacteria, flora and pH, but to Candida infection and to glycogen concentration. Using a Y----M good-responder Candida strain in the vaginal test it is possible to have a global index of the factors affecting the Candida filamentation in the host. It can be advisable to utilize the vaginal test as a virulence test for Candida strains and as an indicative test of phenotypic drug resistance.     

Voriconazole activity against clinical yeast isolates: a multicentre Italian study

The activity of voriconazole was tested in vitro against 1996 clinical yeast isolates collected in 20 Italian microbiology laboratories. Voriconazole susceptibility testing was carried out with the broth microdilution (NCCLS M27-A2), Etest and disk diffusion methods. The minimum inhibitory concentrations at which 90% of the isolates were inhibited (MIC90) obtained with the NCCLS method were 0.03 mg/L for Candida albicans, 0.5 mg/L for Candida non-albicans and 0.25 mg/L for other genera; those obtained with Etesting were, respectively, 0.032 mg/L, 0.125 mg/L and 0.125 mg/L. With the disk diffusion method, the majority of isolates (92.3%) showed inhibition zone diameters between 21 mm and 40 mm. Using a tentative MIC cut-off of 1mg/L as indicative of in vitro susceptibility, 98.1% of the isolates tested in our study would be classified as susceptible, and only 28 (1.4%) of the isolates, with MICs higher than 2mg/L, would be classified as resistant to the drug. Our findings confirm the broad-spectrum in vitro activity of voriconazole against yeasts, including Candida species that are generally less susceptible to other azoles.     

In vitro antifungal activity of itraconazole, a new triazole antifungal agent, against clinical isolates from patients with systemic mycoses]

The in vitro antifungal activity of itraconazole (ITZ), a new oral triazole antifungal agent, against clinical isolates from patients with systemic mycoses were compared with those of existing systemic antifungals, viz. ketoconazole (KCZ), miconazole or amphotericin B. The studies were performed with 65 isolates of pathogenic yeasts and 13 isolates of Aspergillus spp. using the agar dilution method on casitone agar. ITZ showed the most potent antifungal activities against isolates of pathogenic yeasts including several Candida spp. (Candida parapsilosis, Candida krusei, Candida guilliermondii), Cryptococcus neoformans, Trichosporon cutaneum (MIC less than or equal to 0.08 micrograms/ml) and Aspergillus spp. including Aspergillus fumigatus (MIC less than or equal to 5 micrograms/ml). On the other hand, activities of ITZ against isolates of other Candida spp. such as Candida albicans and Candida glabrata were lower than those of KCZ and other reference drugs. Some isolates of C. albicans and C. tropicalis were not completely inhibited by ITZ even at concentrations above 10 micrograms/ml on casitone agar. However, in the micro-broth dilution method using synthetic amino acid medium, fungal as the test medium, ITZ completely inhibited the growth of all these isolates at drug concentrations of less than or equal to 0.20 micrograms/ml.     

特比萘芬与氟康唑或伊曲康唑体外联合抗白念珠菌的作用

目的探讨特比萘芬与氟康唑或伊曲康唑体外联合抗白念珠菌的作用。方法采用微量液体稀释法测定特比萘芬、氟康唑、伊曲康唑对生殖器部位分离的36株白念珠菌药敏试验，应用棋盘微量稀释法测定特比萘芬与氟康唑或伊曲康唑对36株白念珠菌的联合药敏试验。结果白念珠菌菌株对氟康唑、伊曲康唑、特比萘芬耐药株分别为3株（8．33％）、4株（11．11％）、6株（16．67％）。特比萘芬和氟康唑联用MIC几何平均数较其单独应用均显著降低（t=3．590，P〈0．05；t=3．252，P〈0．05），15株有协同作用（42％），18株有相加作用（50％），3株无关作用（8％）；特比萘芬和伊曲康唑联用后的MIC几何平均数较其单独应用均显著降低（t=3．849，P〈0．001；t=2．409，P〈0．05），表现为协同作用有14株（39％），相加作用的有17株（47％），无关作用的有5株（14％）；均未发现拮抗作用。结论特比萘芬与氟康唑或伊曲康唑联合应用对大部分白念珠菌能产生协同作用和相加作用，提示特比萘芬与氟康唑或伊曲康唑联合应用能增强抗白念珠菌的作用。