临床常见真菌的分布和药物敏感性分析

目的:了解真菌感染的临床分布、真菌种类及耐药情况,为临床诊治提供依据。方法:采用沙保弱平板或CHROMa-gar平板进行菌株分离、API Candida、API20CAUX菌株鉴定,用Rosco纸片扩散法测定药敏。结果:690份标本,分离出700株真菌,其中假丝酵母菌属占53.5%,白假丝酵母菌占25.6%;痰标本占24.3%;住院患者中以ICU和肾内科分离率高且以白假丝酵母菌为主,分别占59.3%和45.2%;门诊患者以皮肤科分离率高,以近平滑假丝酵母菌为主,占23.4%;酵母样真菌对伊曲康唑、氟康唑、两性霉素B、制霉菌素、酮康唑的敏感率分别为89.4%、83.9%、98.2%、95.9%、96.0%。结论:假丝酵母菌是真菌培养中分离率最高的真菌,分离的主要真菌种类因科室和患者而异。真菌的分离、鉴定和药敏试验对临床使用抗真菌药物具有指导意义,特别是对氟康唑天然耐药菌株的鉴定,有利于抗真菌药物选择。     

811例酵母样真菌感染的临床分布及药敏分析

目的分析临床酵母样真菌感染的分布情况,结合真菌的鉴定及药敏,指导临床合理用药。方法回顾性分析真菌感染者的临床资料、检出的酵母样真菌的分布及对抗真菌药物的耐药特点。结果真菌感染以60岁以上老年人居多,占69.4%,感染部位主要为呼吸道、泌尿道及肠道;基本都有抗生素使用史,多有创伤性介入治疗。检出真菌主要为白色假丝酵母菌,共526例,另有热带假丝酵母菌117例,光滑假丝酵母菌86例,近平滑假丝酵母菌57例,其他酵母菌25例。10种抗真菌药物中,耐药性较高的为特比奈芬、制霉菌素和两性霉素B,比较敏感的为5-氟胞嘧啶和酮康唑。两性霉素B33.9%和氟康唑22.6%的耐药率,大大高于以往熟知的程度,这与临床大量常规使用其预防真菌感染有密切联系。结论应加强真菌检测,指导临床合理使用抗生素,减少多重耐药出现。     

儿童真菌感染的病原学研究

目的探讨广州地区儿童真菌感染的病原分布特点及其耐药状况,为防治儿童真菌感染提供实验室依据。方法对患儿感染部位的真菌进行分离培养和鉴定：以ATB^TM FUNGUS3酵母样真菌药敏试验条进行常用抗真菌药物的敏感性分析。结果从患儿标本中分离出558株真菌,主要来自呼吸道有299株,占53．58％;其次是消化道、伤口（创口）、泌尿系统和血液等,分别占28．14％、6．27％、4．66％、3．76％。其中白色假丝酵母菌367株,占65．77％;其次为热带假丝酵母菌、光滑假丝酵母菌、近平滑假丝酵母菌、克柔假丝酵母菌、季也蒙假丝酵母菌等,分别占15．28％、5．02％、4．48％、3．41％、2．69％。从骨髓中检出5株马尔尼菲青霉,从脑脊液中检出3株新型隐球菌。真菌对两性霉素B、5-氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑等总耐药率分别为8．78％、4．84％、10．54％、1．36％、0．85％。结论引起儿童真菌感染的主要病原菌是白色假丝酵母菌。对真菌感染应该有针对性地使用高效的抗真菌药物进行早期治疗。     

侵袭性真菌感染237例治疗分析

目的观察侵袭性真菌感染应用氟康唑、伊曲康唑和两性霉素B治疗的临床疗效及安全性。方法选择南方医科大学附属南方医院2002年2月至2007年2月收治的侵袭性真菌感染患者237例，单用常规剂量氟康唑107例、伊曲康唑84例、两性霉素B46例；氟康唑治疗无效者改用伊曲康唑39例和两性霉素B26例．伊曲康唑治疗无效改用两性霉素B和脂质体两性霉素B39例。结果237例侵袭性真菌感染总的治愈率和有效率分别为54．85％和72．57％。单用氟康唑治疗组的有效率显著低于伊曲康唑和两性霉素B治疗组，分别为39．25％、53．57％和56．52％（P〈0．05）；用氟康唑治疗无效改用伊曲康唑或两性霉素B治疗的有效率分别为76．93％和84．61％。结论伊曲康唑和两性霉素B抗真菌谱广且疗效相似，优于氟康唑；氟康唑和伊曲康唑安全性良好，而两性霉素B的不良反应发生率高。     

新生儿重症监护病房真菌血症病原学及临床分析

目的探讨自2004年1月至2008年12月我院新生儿重症监护病房获得性真菌血症病原学及临床特征,为真菌血症防治提供依据。方法回顾分析5年中新生儿重症监护室发生的33例真菌血症的病原学和临床资料。结果33例真菌血症均为医院获得感染的假丝酵母菌,其中白色假丝酵母菌17株、热带假丝酵母菌10株、近平滑假丝酵母菌5株、光滑假丝酵母菌1株。结论假丝酵母菌属是新生儿重症监护病房真菌血症的主要致病菌,以白色假丝酵母菌最常见,但非白色假丝酵母菌也占较大比例;真菌血症与早产、极低体重儿、机械通气、静脉导管、全胃肠外营养等因素有关。5-氟脲嘧啶、伊曲康唑、两性霉素B和氟康唑对假丝酵母菌耐药性较低,氟康唑是治疗假丝酵母菌属的有效药物。     

可宝净栓联合伊曲康唑治疗复发性外阴阴道假丝酵母菌病的临床观察

目的观察可宝净栓及伊曲康唑联合治疗复发性外阴阴道假丝酵母菌病的疗效及复发情况。方法选择2003～2004年我院妇科门诊确诊为复发性外阴阴道假丝酵母菌病的患者110例,随机分成3组,A组40例给予可宝净栓阴道上药,日一次,每次1片,连用18d,月经期不间断。B组40例给予可宝净栓阴道上药,用法同A组,同时口服抗真菌药物斯皮仁诺200mg,口服,每日一次,共三次。C组,30例,单纯给予斯皮仁诺200mg口服,每日一次,共3次。用药后1个月复诊,以后随访达半年,观察治疗效果,及有无复发。结果联合用药组疗效最好,且复发率最低。结论可宝净栓联合伊曲康唑治疗RVVC疗效显著,且可明显降低VVC复发率。     

医院内真菌感染的病原种类和耐药性分析

目的研究某教学医院侵袭性真菌感染的发病率、耐药性和病原分布特点,为临床医师合理用药提供科学依据。方法回顾分析2008-2010年住院患者真菌培养的检出率、标本来源、菌种分布及其对常见抗真菌药物的耐药性。结果医院内侵袭性真菌感染近3年的检出率19.32%,2008-2010年真菌检出率呈逐年上升的趋势,2008与2009年、2009与2010年差异有统计学意义（χ2=7.61、69.33,P〈0.05）;感染部位以呼吸道最多,其次为泌尿道;检出的真菌种类以假丝酵母菌属为主,约占99.78%,且白色假丝酵母菌居多,占49.04%。白假丝酵母菌和热带假丝酵母菌对三唑类药物敏感性仍较好,光滑假丝酵母菌及其他两种真菌则对三唑类药物耐药率较高,所有菌株对两性霉素B均较敏感。结论白色假丝酵母菌仍是医院内侵袭性真菌感染的主要病原菌,临床应根据药物敏感试验结果合理使用抗生素,防止侵袭性真菌的发生,延缓其耐药性的进一步发展。     

特比萘芬与氟康唑或伊曲康唑联合对氟康唑诱导耐药稳定白念珠菌的影响

目的探讨特比萘芬与氟康唑或伊曲康唑联合抗氟康唑诱导产生的耐药稳定白念珠菌的作用.方法采用多步诱导法,在YEPD培养基中,利用氟康唑诱导白念珠菌敏感株产生耐药稳定菌株.根据美国国家临床实验标准委员会（NCCLS）制定的标准,采用棋盘微量稀释法测定特比萘芬与氟康唑或伊曲康唑对耐药稳定菌株的联合药敏试验,并对诱导耐药稳定菌株ERG11基因的编码区序列进行DNA测序.结果临床敏感菌株和标准敏感菌株能被诱导形成耐药菌株,但大部分不稳定,诱导耐药稳定株ERG11基因的编码区DNA测序有突变点存在,特比萘芬与氟康唑或伊曲康唑联用对诱导耐药稳定株可产生协同作用.结论特比萘芬与氟康唑或伊曲康唑联合应用对基因突变产生的耐药株有协同作用,可阻止或延迟氟康唑诱导的耐药性白念珠菌菌株的产生.     

儿童马尔尼菲青霉菌感染的鉴定及该菌酵母相的体外药敏分析

目的确定患儿体内所感染的病原体为马尔尼菲青霉菌（PM），并用E—test法测定该菌酵母相的药物敏感性，指导临床合理用药。方法取患儿血液、骨髓涂片染色镜检和真菌双相培养，观察真菌生长情况及菌落形态，显微镜下观察菌体特征。并采用M27-P方案中的E—test法测定6株PM的酵母相（yeast）对伊曲康哇、酮康哇、5-氟胞嘧啶、氟康唑、两性霉素B的MIC值。结果PM为双相性真菌，于25℃为青霉相，于57℃为酵母相，并均有典型的菌落形态特征。瑞氏染色可见菌体呈圆形、椭圆型或腊肠样，大小不一，直径2～8pm，胞壁染紫色且清楚连续，在腊状的细胞内可见一明显的横隔。该菌37℃酵母相时伊曲康哇、酮康哇、5-氟胞嘧啶、氟康唑、两性霉素B的MIC范围分别为0．002—0．016μg／mL、0．012～0．125μg／mL、0．032～0．380μg／mL、1．500-6．000μg／mL、0．047～2．000μg／mL，对酮康唑、5-氟胞嘧啶出现耐药株各1株，对两性霉素B耐药株2株。结论马尔尼菲青霉菌的特征性菌落形态和骨髓及外周血发现的真菌孢子对该菌有诊断价值，而药敏结果显示该菌对伊曲康唑敏感性最强,其次为5-氟胞嘧啶、氟康唑、酮康唑 ,两性霉素B敏感性最弱。     

流式细胞术快速检测假丝酵母菌药物敏感性方法的建立及应用北大核心CSCD

目的：建立基于流式细胞分析技术快速检测假丝酵母菌临床菌株药物敏感性或耐药性的方法。方法以碘化丙锭（ PI）为荧光染料,采用白假丝酵母菌ATCC90029株确定流式药敏试验门设置及最佳实验条件。采用所建立的真菌流式药敏试验检测110株假丝酵母菌临床菌株对氟康唑和伏立康唑的敏感性或耐药性并经典的M27-A3常量稀释法进行比较。结果调整电压可将白假丝酵母菌ATCC90029株活菌与死菌在流式细胞仪SS/log（ FL3）门中分为边界清晰的两群细胞,不同比例死菌与活菌混合液与流式药敏试验检测值之间有高度相关性（r＝0．999）。流式药敏试验30 min内可出结果,其最适菌液浓度为1．0×106/ml、药物与真菌最适孵育时间为3 h、最佳染色方法及时间为脱氧胆酸钠预处理后PI染色5 min。流式药敏试验与M27-A3常量稀释法对110株假丝酵母菌临床菌株对氟康唑和伏立康唑敏感或耐药总符合率分别为98．2％和87．3％。结论较之经典的常量稀释法,流式药敏试验用于检测真菌对药物的敏感性或耐药性具有快速、准确、敏感等优点,具有临床应用前景。     

臭氧治疗外阴阴道假丝酵母菌病的临床观察

目的观察臭氧对外阴阴道假丝酵母菌病（VVC）的治疗效果。方法将102例VVC患者随机分为观察组（51例）和对照组（51例）,观察组接受臭氧治疗,对照组接受达克宁硝酸咪康唑栓治疗。两组于治疗后第3天进行临床和真菌学疗效分析。结果治疗结束后第3天,观察组治愈42例（82．3％）、显效6例（11．8％）、有效3例（5．3％）,总有效率为100％;对照组治愈28例（55．0％）、显效12例（23．5％）、有效6例（11．8％）、总有效率为90．3％。两组治愈率差异有统计学意义（P〈0．01）。结论臭氧治疗外阴阴道假丝酵母菌病效果显著,不良反应发生率低。     

In vitro susceptibilities and biotypes of Candida albicans isolates from the oral cavities of patients infected with human immunodeficiency virus.

Candida albicans strains were isolated from the oral cavities of 62 human immunodeficiency virus (HIV)-infected patients at different stages of HIV infection. Only patients with persistent generalized lymphadenopathy-acquired immunodeficiency syndrome (AIDS)-related complex or full-blown AIDS showed typical clinical symptoms for oral candidiasis. In general, the microbiological recovery of Candida strains from the oral cavity increased with more advanced stages of HIV infection. The antifungal activity of ketoconazole, itraconazole, nystatin, amphotericin B, and flucytosine against all 62 strains was evaluated by means of a photometer-read broth microdilution method for determination of the 30% inhibitory concentrations of the drugs. The 95% ranges of 30% inhibitory concentrations were as follows: less than or equal to 0.063 to 32 micrograms/ml for ketoconazole, less than or equal to 0.063 to 8 micrograms/ml for itraconazole, 0.5 to 4 micrograms/ml for nystatin, less than or equal to 0.063 to 4 micrograms/ml for amphotericin B, and less than or equal to 0.063 to 8 micrograms/ml for flucytosine. Two strains were resistant to flucytosine, one was resistant to ketoconazole, and three were resistant to itraconazole. Isolates from patients with full-blown AIDS showed significantly less susceptibility to itraconazole, amphotericin B, and flucytosine. Strains were biotyped by using the API 20C carbohydrate assimilation system. The major biotype accounted for 63.9% of the isolates. At repeated evaluation, a change in biotype pattern was seen in 27.3%.     

Therapeutic options for the management of oropharyngeal and esophageal candidiasis in HIV/AIDS patients

Mucocutaneous candidiasis is frequently one of the first signs of HIV infection. Over 90% of patients with AIDS will develop oropharyngeal candidiasis at some time during their illness. Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole), have replaced older topical antifungals (gentian violet and nystatin) in the management of oropharyngeal candidiasis in these patients. The systemic azoles, itraconazole and fluconazole, are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. A concern in these patients is clinical relapse, which appears to be dependent on degree of immunosuppression and is more common following clotrimazole and ketoconazole than following fluconazole or itraconazole. Candida esophagitis is also of concern, since it occurs in more than 10% of patients with AIDS. Fluconazole is an integral part of the management of mucosal candidiasis. A cyclodextrin oral solution formulation of itraconazole has clinical response rates similar to fluconazole and is an effective alternative. In patients with fluconazole-refractory mucosal candidiasis, treatment options include itraconazole, amphotericin B oral suspension, and parenteral amphotericin B.     

Therapeutic Options for the Management of Oropharyngeal and Esophageal Candidiasis in HIV/AIDS Patients

Abstract

Mucocutaneous candidiasis is frequently one of the first signs of HIV infection. Over 90% of patients with AIDS will develop oropharyngeal candidiasis at some time during their illness. Although numerous antifungal agents are available, azoles, both topical (clotrimazole) and systemic (fluconazole, itraconazole), have replaced older topical antifungals (gentian violet and nystatin) in the management of oropharyngeal candidiasis in these patients. The systemic azoles, itraconazole and fluconazole, are generally safe and effective agents in HIV-infected patients with oropharyngeal candidiasis. A concern in these patients is clinical relapse, which appears to be dependent on degree of immunosuppression and is more common following clotrimazole and ketoconazole than following fluconazole or itraconazole. Candida esophagitis is also of concern, since it occurs in more than 10% of patients with AIDS. Fluconazole is an integral part of the management of mucosal candidiasis. A cyclodextrin oral solution formulation of itraconazole has clinical response rates similar to fluconazole and is an effective alternative. In patients with fluconazole-refractory mucosal candidiasis, treatment options include itraconazole, amphotericin B oral suspension, and parenteral amphotericin B.     

Torulopsis glabrata. Morphologic characteristics, biotyping and sensitivity to isolates of antifungal agents in vitro]

The authors described morphological and biochemical properties of twenty strains of Torulopsis glabrata and two strains of T. candida and T. sphaerica, mostly of human origin. By means of eight biotyping tests based on the evaluation of so-called resistograms the isolates of T. glabrata were divided into eight biotypes. The authors discussed the problem of possible use of biotyping of T. glabrata in investigations of the epidemiology and pathogenesis of mycoses caused by this microorganism. In investigations of the sensitivity of strains of Torulopsis spp. to nine antimycotic agents in vitro it was revealed that the isolates were sensitive to all polyene antibiotics (amphotericin B, nystatin and pimaricin) and to 5-fluorocytosine. The sensitivity to azole chemotherapeutic agents (clotrimazole, econazole, miconazole, ketoconazole and itraconazole) was more varied: some strains were resistant to clotrimazole and econazole.     

广东地区2126例泌尿生殖道支原体感染及药敏结果分析

目的了解广东地区泌尿生殖道支原体感染的情况以及对药物的敏感性。方法采用支原体培养、鉴定、计数及药敏一体化试剂盒对2126例泌尿生殖系感染患者进行检测及药物敏感性试验。结果2126例中支原体阳性1080例，阳性率为50．80％。其中解脲支原体（Uu）、人型支原体（Mh）及解脲和人型支原体（Uu＋Mh）混合感染的阳性率分别为37．53％（798例）、2．72％（58例）、10．54％（224例）。Uu对12种抗菌药物敏感性依次是克拉霉素（89．15％）、美满霉素（87．00％）、强力霉素（86．00％）和四环素（81．80％），Mh敏感性较高的依次是强力霉素（95．20％）、美满霉素（95．20％）和交沙霉素（84．10％），Uu＋Mh对12种抗生素的敏感性均较差。结论广东地区支原体感染主要以Uu为主。其次是Uu＋Mh混合感染；Uu、Mh和Uu＋Mh三者对抗生素的敏感性存在一定的差异，临床上应根据支原体培养及药敏试验结果合理用药，以最大限度地控制新耐药菌株的产生。     

外阴阴道念珠菌病易感因素的分析

目的探讨影响女性外阴阴道念珠菌病发病的易感因素。方法通过病例对照研究，分析比较社会文化、环境、疾病史及生活习惯等多种因素与外阴阴道念珠菌病发病的关系。结果工作压力大、自身手足癣、常穿紧身裤、洗衣机洗涤内裤、非经期使用卫生护垫、外阴药液清洗等因素在病例组中的发生率明显高于对照组（P〈0．05）。清洁外阴毛巾经常晾晒、内裤经常晾晒、内裤全棉质地在病例组中的发生率明显低于对照组（P〈0．05）。结论外阴阴道念珠菌病好发于月经前期，其发病与环境因素及多种生活卫生习惯有关。     

Prevalence, susceptibility profile and proteinase production of yeasts causing vulvovaginitis in Turkish women

In this study the prevalence of vulvovaginal candidiasis (VVC), antifungal susceptibility and proteinase production of isolated Candida species were investigated. Vaginal swabs were collected from symptomatic women with vulvovaginitis attending the Obstetrics and Gynecology Clinic of Kocaeli University, Turkey. The relation between risk factors, such as pregnancy, diabetes mellitus, antibiotic and corticosteroid use, history of sexually transmitted diseases and contraceptive methods, was recorded. Candida spp. were identified by conventional methods, then evaluated for proteinase secretion in a medium containing casein. Antifungal susceptibility was determined according to the NCCLS microdilution method. The prevalence of women with vulvovaginitis was 35.7% (170/6080) and 16% (28/170) of them were diagnosed as VVC. Candida albicans was the dominant species: 21 (75%), followed by 4 C. glabrata (14%), 2 C. tropicalis (7%), and one C. krusei (3.5%). All isolates were susceptible to fluconazole, itraconazole and amphotericin B, except one C. krusei, one C. glabrata and one C. albicans that were resistant to fluconazole. Proteinase production was determined in 19 (90.5%) C. albicans and in all C. tropicalis isolates. Proteinase activity was not associated with antifungal resistance. No association was found between risk factors and VVC.     

铜绿假单胞菌的药物敏感试验结果分析

目的了解铜绿假单胞菌在本院的分布及对抗生素的敏感情况,为临床治疗提供科学依据。方法回顾性调查本院2008年1月至2009年10月住院及门诊患者各种标本分离的铜绿假单胞菌的分布及对抗生素的敏感情况。结果铜绿假单胞菌在呼吸道标本的检出率最高,占63.8%,其次是伤口分泌物标本,占18.3%,尿液标本占9.2%,血液标本占2.5%;其对11种抗生素的敏感率最高是妥布霉素,其次是哌拉西林/他唑巴坦,检出多重耐药株约占35%,未出现泛耐药株。结论根据药敏结果合理使用抗生素,并重视对多重耐药株的监测工作,可有效控制感染。     

Antifungal resistance: an emerging problem in Mexico

BACKGROUND: An increase in mycosis associated with therapeutic failure has been observed worldwide. The dearth of data in Mexico led us to study antifungal resistance. MATERIAL AND METHODS: Seventy six isolates of patients from the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social were included: 36 with dermatophytoses and 40 with candidiasis. Dermatophytes were assesed using the E-test method and Candida spp. using the broth microdilution method. Antifungal drugs included itraconazole, ketoconazole and fluconazole for dermatophytes; in addition, voriconazole and amphotericin B were used to treat yeasts. RESULTS: From the 36 dermatophytes, seven isolates (19.4%) showed resistance to one or more antifungal drugs: three to Trichophyton rubrum, three to T. mentagrophytes and one to T. tonsurans. One T. rubrum isolate was resistant to the three azoles; the other six isolates were resistant to fluconazole only. From the 40 Candida isolates, 11 (27.5%) showed resistance: seven to ketoconazole and itraconazole; three only to itraconazole and one to ketoconazole. One C. glabrata isolate showed resistance to the four azoles. None of the yeasts showed resistance to amphotericin B. CONCLUSION: Therapeutic failure could be caused by drug resistance. In our study we found an antifungal resistance of 20% and 27.5% in dermatophytes and in yeasts respectively.