1015株念珠菌感染的病原菌分类和药敏分析

目的了解医院念珠菌感染的病原菌分类及对氟康唑的敏感性. 方法采用微量稀释法和改良纸片法测定临床标本分离的各类念珠菌对氟康唑的敏感性. 结果共分离出1 015株念珠菌,其中白色念珠菌占49.4%,热带念珠菌占19.1%,克柔念珠菌占10.1%,光滑念珠菌占10.5%,其他念珠菌占10.9%;对氟康唑的耐药率白色念珠菌为1.6%、热带念珠菌为0%、克柔念珠菌为25%、光滑念珠菌为40%、其他念珠菌为8.4%. 结论念珠菌在临床标本中的分布已发生变化,白色念珠菌比例下降但还是最常见念珠菌感染的病原菌,非白色念珠菌比例有所上升,氟康唑对白色念珠菌、热带念珠菌有极好的抗菌活性,而对克柔念珠菌、光滑念珠菌的抗菌活性较差,临床经验用药应依据药敏结果合理选用.     

A one-year survey of candidemia in Belgium in 2002

A total of 211 episodes of bloodstream yeast infections in 207 patients, hospitalized in 28 Belgian hospitals participating in a National Surveillance Program, were evaluated. A total of 81% of the patients were more than 50 years of age. Candida albicans was the cause of infections in 55% of patients, 22% were due to C. glabrata and 13% to C. parapsilosis. The most common predisposing factors were antibacterial therapy (42%), residence in an intensive care unit (32.9%) and presence of an intravascular catheter (29.7%). Most patients had more than one predisposing factor. Fluconazole alone or in association with another antifungal agent was the treatment of choice for 89.7% of the cases. In vitro susceptibility testing of the isolates revealed that 99% were susceptible to amphotericin B, 95% to 5-fluorocytosine, 82% to fluconazole and 69% to itraconazole. Resistance to azoles was more common among C. glabrata isolates in the elderly. We conclude that the frequency of C. albicans infection is decreasing in Belgium and this is associated with the emergence of other species, most notably, C. glabrata.     

老年下呼吸道感染患者痰分离真菌种类及药物敏感性

目的了解老年患者下呼吸道痰标本中真菌种类分布及药物敏感性,为预防真菌感染及针对性诊治提供依据。方法收集2010年1月—2014年10月云南亚高原地区3所医院老年患者下呼吸道标本分离的真菌,对其进行鉴定和药物敏感性试验。结果1 887株真菌中,白假丝酵母菌最多,占65.18%,同时,分离出毛霉菌属（0.69%）、构巢曲霉菌（0.16%）等少见菌株;分离的菌株对制霉菌素、两性霉素B和伊曲康唑的敏感率较高,分别为100.00%、90.14%和88.98%;对氟康唑和咪康唑的耐药率较高,分别为34.29%和36.62%;5种常见酵母菌对制霉菌素均敏感,但白假丝酵母菌、光滑假丝酵母菌对氟康唑、咪康唑的耐药率达35.94%~40.88%,白假丝酵母菌对5 氟胞嘧啶的耐药率为19.51%。结论对老年人临床抗真菌治疗需要考虑真菌类别及药敏结果。     

43株念珠菌分离鉴定和药敏试验研究

[目的]了解皮肤病、性病门诊就诊者念珠菌感染状况及其对抗真菌药物敏感性，为该菌的防治提供依据。[方法]用VITEK32细菌鉴定仪对念珠菌进行鉴定，用MTT法进行药物敏感性试验。[结果]从85份临床标本分离到43株念珠菌，阳性分离率为50．6％。其中白念珠菌30株（69．8％）、近平滑念珠菌6株（14．0％）、光滑念珠菌4株（9．3％）、季也蒙念珠菌2株（4．7％）、丛生丝孢酵母菌1株（2．3％）。MTT法测定念珠菌对氟康唑和伊曲康唑的总敏感率分别为93．0％和67．4％，与常规法比较差异无统计学（P〉0．05）。[结论]白念珠菌仍是最常见的致病念珠菌。念珠菌对氪康唑的总敏感率略高于伊曲康唑，对氟康唑耐药的菌株往往对伊曲康唑也耐药。     

Susceptibilities of Candida species to amphotericin B and fluconazole: the emergence of fluconazole resistance in Candida tropicalis.

OBJECTIVE: To determine the susceptibilities of Candida species isolated from Taiwan to amphotericin B and fluconazole. DESIGN: Prospective surveillance study. METHODS: Each hospital was asked to submit up to 10 C. albicans and 40 non-albicans Candida species during the collection period, from April 15 to June 15, 1999. One isolate was accepted from each episode of infection. The broth microdilution method was used to determine susceptibilities to amphotericin B and fluconazole. RESULTS: Only 3 of 632 isolates, one each of C. famata, C. krusei, and C. tropicalis, were resistant to amphotericin B. A total of 53 (8.4%) of 632 clinical yeast isolates, consisting of 4% C. albicans, 8% C. glabrata, 15% C. tropicalis, and 70% C. krusei, were resistant to fluconazole. In contrast, no C. parapsilosis isolate was resistant to fluconazole. Isolates from tertiary-care medical centers had higher rates of resistance to fluconazole than did those from regional and local hospitals (11.4% vs 6.6%). Isolates from different sources showed different levels of susceptibility to fluconazole. All of the isolates with the exception of C. tropicalis and C. krusei isolated from blood were susceptible to fluconazole. A pattern of co-resistance to both amphotericin B and fluconazole was observed. CONCLUSIONS: Non-albicans Candida species had higher rates of resistance to fluconazole than did C. albicans (44 of 395 [11.2%] vs 9 of 237 [3.8%]; P = .002). The increasing rate of fluconazole resistance in C. tropicalis (15%) is important because C. tropicalis is one of the most commonly isolated non-albicans Candida species.     

血液病合并侵袭性真菌感染病原学及危险因素

目的了解血液病合并侵袭性真菌感染(IFI)的现状,分析真菌耐药情况及感染的危险因素。方法回顾性分析2006—2010年某院血液病科合并感染的患者1 246例次,对IFI患者病原学特点及危险因素进行分析。结果真菌感染281例次,分离真菌162株,感染部位以呼吸道(134株,占82.72%)为主。4种主要酵母菌为白假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌和克柔假丝酵母菌;2006—2009年均以白假丝酵母菌为主,2010年非白假丝酵母菌超过白假丝酵母菌。4种主要酵母菌对氟康唑和伊曲康唑的总耐药率分别为5.15%和4.41%,6株克柔假丝酵母对氟康唑和伊曲康唑全部耐药,未发现对伏立康唑耐药的菌株。真菌感染的独立危险因素为合并糖尿病、粒缺时间14 d。结论血液病患者非白假丝酵母菌感染比例增加,出现了耐氟康唑和伊曲康唑的非白假丝酵母菌,需采取综合措施积极预防及早期治疗IFI患者。     

大蒜素、氟康唑对医院感染酵母菌的体外抗菌活性研究

目的研究大蒜素、氟康唑对临床分离酵母菌的体外抗菌活性,比较中西药对酵母菌的耐药现状.方法286株酵母菌由住院患者各类感染标本中分离,菌种采用全自动微生物鉴定仪VITEK YBC卡鉴定,用琼脂稀释法测定大蒜素和氟康唑对酵母菌的最低抑菌浓度(MIC),比较大蒜素和氟康唑对酵母菌的MIC50、MIC90.结果经鉴定临床分离的酵母菌中,白色假丝酵母菌最常见,占67.6%,其次为热带假丝酵母菌17.5%、光滑假丝酵母菌8.4%、近平滑假丝酵母菌3.5%等;大蒜素对各类酵母菌均有抑菌作用;氟康唑对白色假丝酵母菌、热带假丝酵母菌及近平滑假丝酵母菌的敏感率较高.结论医院深部酵母真菌感染及耐药性呈上升趋势,提示临床在不明确何种酵母菌感染的情况下,中西药联合使用,可能得到好的疗效.     

妇产科假丝酵母菌性阴道炎的菌种分布及耐药性

目的 了解妇产科患者假丝酵母菌性阴道炎的菌种分布及耐药性,为临床合理选择抗真菌药物提供参考依据.方法 严格按照卫生部《全国临床检验操作规程》,用萨布罗培养基分离真菌,采用常规方法鉴定假丝酵母菌属;药敏试验采用K-B法进行.结果 自387例阴道炎患者的阴道分泌物中检出6种假丝酵母菌,以白色假丝酵母菌分离率最高,为291株占75.2％,其次为热带假丝酵母菌39株占10.1％;6种假丝酵母菌对两性霉素B、制霉菌素的敏感率均为100.0％,对氟康唑、克霉唑、伊曲康唑等抗真菌药物的耐药率在6.2％～33.3％.结论 检出真菌已产生了不同程度的耐药性,且不同真菌耐药性具有较大的差异,因此,应重视真菌的检测及药敏试验,以指导临床合理用药.     

真菌菌血症相关危险因素及药敏试验分析

目的 总结10年真菌菌血症流行病学、病原谱及药敏特点,为真菌菌血症防治提供依据.方法 回顾性调查分析1998-2007年医院发生的75例真菌菌血症.结果 共分离出91株病原菌,主要为白色假丝酵母菌、光滑假丝酵母菌;广谱抗菌药物的使用率为93.3％,白色假丝酵母菌与非白色假丝酵母菌组间相关因素比较差异无统计学意义,氟康唑对白色假丝酵母菌的敏感率为98.1％,对光滑假丝酵母菌的敏感率达到86.4％.结论 广谱抗菌药物的应用,可能是真菌菌血症的最常见的危险因素,氟康唑对于白色假丝酵母菌和光滑假丝酵母菌仍有较高的敏感率.     

阴道分泌物中白假丝酵母菌蛋白酶的致病性和耐药性研究

目的:检测阴道分泌物(白带)中白假丝酵母菌对人体的致病性,探讨其对抗真菌药物的敏感性。方法:采用沙堡葡萄糖琼脂平板法对阴道分泌物标本中分离的218株白假丝酵母菌进行蛋白酶活力测定。然后用Rosco纸片扩散法检测218株白假丝酵母菌对伊曲康唑、氟胞嘧啶、二性霉素B、酮康唑、氟康唑、制霉菌素、益康唑、咪康唑等抗真菌药物的敏感性。结果:218株白假丝酵母菌全部检出蛋白酶,其中蛋白酶活力高的为177株,占81.20%;活力中等的为32株,占14.68%;活力低的为9株,占4.13%。患者组蛋白酶阳性菌株的检出率及其蛋白酶的活力均显著高于携带者组(P<0.01)。白假丝酵母菌对制霉菌素、二性霉素B和氟胞嘧啶的敏感率均较高,分别为95.00%、89.00%和84.50%;其次为酮康唑和伊曲康唑,其敏感率分别为30.70%和11.90%;益康唑、咪康唑和氟康唑的敏感率较低,分别为7.30%、5.00%和1.80%。结论:蛋白酶是白假丝酵母菌的重要毒力因子,蛋白酶活力可直接反映人体感染毒力强弱和致病程度的客观指标。白假丝酵母菌对抗真菌药物易产生耐药性。因此开展对白假丝酵母菌的鉴定及药物敏感性检测,为指导临床抗感染治疗和合理选择药物,有效控制和减少真菌感染而奠定理论基础。     

Long-term epidemiological survey of Candida species: comparison of isolates found in an intensive care unit and in conventional wards

The aim of this study was to compare the distribution of Candida species in patients hospitalized in an intensive care unit (ICU) and in conventional wards. A retrospective analysis was performed covering an 18-year period in a 700-bed teaching hospital. Various body sites were investigated in all patients admitted during the study and isolates were identified by microscopic and macroscopic morphology, and by commercially available kits. The susceptibility of strains to amphotericin B and flucytosine was assessed by the ATB-fungus system, itraconazole and fluconazole by Etest. No difference was observed between the distribution of Candida species in ICU and in conventional wards. Candida albicans represented about 70% of isolates and Candida glabrata was the second most common species involved in infection or colonization. The small number of C. glabrata resistant to fluconazole suggested this antifungal agent as suitable empirical treatment for non-immunocompromized patients in whom a fungal infection was suspected.     

1312株酵母菌的鉴定及其药敏分析

目的 分析临床标本中酵母菌的菌种分布及其对5种常用抗真菌药物的敏感性,帮助临床合理使用抗真菌药物. 方法 采用显色培养基和VITEK 32的YST鉴定卡对2009-2010年海口市人民医院临床送检的标本进行分离鉴定,并用ATB FUNGUS 3进行体外药物敏感性检测及耐药分析. 结果 1312株酵母菌中,其中白色念珠菌最多为825株(62.9％),其次为热带念珠菌206株(15.7％)和光滑念珠菌198株(15.1％).体外药敏检测结果显示氟康唑、伏立康唑对白色念珠菌、近平滑念珠菌、热带念珠菌的敏感率达90％以上;伊曲康唑对白色念珠菌和近平滑念珠菌敏感率大于80％;两性霉素B对各念珠菌的敏感率都大于95％. 结论 1312株酵母菌中白色念珠菌的比例最高,其次为热带念珠菌和光滑念珠菌.体外药敏检测结果显示氟康唑、伏立康唑和两性霉素B的敏感率较好.     

呼吸道标本分离的假丝酵母菌分布及耐药性

目的调查近年住院患者呼吸道标本分离的假丝酵母菌属菌种分布及耐药性变化趋势，为临床合理使用抗真菌药物提供依据。方法对青岛中心医疗集团所属各医院2007-2011年38 326例住院患者送检的呼吸道标本，采用沙保罗培养法培养；VITEX32全自动细菌培养系统YBC鉴定卡或FUNGS CA20进行酵母菌鉴定；ATB FUNGUS 3真菌药敏试验板进行药敏试验。应用WHONET5.4软件对药敏结果进行分析。结果38 326份送检标本共分离假丝酵母菌属2 745株（7.16%），其中白假丝酵母菌2 036株(74.17%)，热带假丝酵母菌348株(12.68%)，光滑球拟酵母菌118株(4.30%)，副秃发酵母菌57株（2.08%)，克柔假丝酵母菌57株（2.08%)，其他假丝酵母菌129株（4.70%）。假丝酵母菌属对常用抗真菌药物的耐药率从高至低依次为伊曲康唑、氟康唑、伏立康唑、氟胞嘧啶、两性霉素B。经χ2检验，所有假丝酵母菌对氟胞嘧啶、两性霉素B、氟康唑的耐药率，2007-2011年无变化（两两比较，P＞0.05）；对伊曲康唑、伏立康唑的耐药率，2007-2011年有所上升（两两比较，P＜0.05）。结论呼吸道感染的假丝酵母菌属以白假丝酵母菌为主；对抗真菌药物已出现不同程度的耐药，并呈增加趋势。     

Synthesis and evaluation of novel 1-(1H-1,2,4-triazol-1-yl)-2-(2,4-difluorophenyl)-3-[(4-substitutedphenyl)-piperazin-1-yl]-propan-2-ols as antifungal agents

A series of 1-(1H-1,2,4-triazol-1-yl)-2-(2,4-difluorophenyl)-3-[(4-substitutedphenyl)-piperazin-1-yl]-propan-2-ols have been designed and synthesized on the basis of the structure-activity relationships and antimycotic mechanism of azole antifungal agents. Their structures were confirmed by elemental analysis, IR, MS, (1)H NMR and (13)C NMR. Results of preliminary antifungal tests against six human pathogenic fungi (Candida albicans, Candida parapsilosis, Cryptococcus neoformans, Candida tropicalis, inherently fluconazole-resistant Candida krusei, Candida glabrata) in vitro showed that all title compounds exhibited activity against fungi tested to some extent except against C. tropicalis. Compound 5b showed higher activity against C. albicans, C. parapsilosis and C. krusei than fluconazole, and its MIC values were determined to be 0.5microg/mL, 1microg/mL and 4microg/mL, respectively. Compound 5k showed higher activities against Torulopsis glabrata than fluconazole (with the MIC value of 2microg/mL). Compounds 5a, 5c, 5f, 5g, 5i exhibited higher activities against C. parapsilosis than fluconazole (with the MIC values of 2microg/mL, 2microg/mL, 2microg/mL, 1microg/mL and 2microg/mL, respectively).     

HSP 90, yeasts and Corynebacterium jeikeium.

Recovery from disseminated candidosis is associated with seroconversion to a 47 kDa breakdown product of the Heat Shock Protein (HSP) 90 of Candida albicans. Cloning, sequencing and epitope mapping has allowed the delineation of the immunodominant epitopes LKVIRKNIVKKMIE and STDEPAGESA. Monoclonal and polyclonal antibodies specific to these epitopes are used to show that all strains of C. albicans tested produce HSP 90 in both the yeast and mycelial phases. Homologous proteins are demonstrated in Saccharomyces cerevisiae, Candida parapsilosis and Corynebacterium jeikeium but not in Torulopsis glabrata. Evidence is presented for the existence of two distinct HSP 90s in C. albicans. The first of these is expressed constitutively whilst the second is produced on heat shocking the yeast from 23 to 37 degrees C.     

常见念珠菌属的临床分布及对抗真菌药物敏感性研究

目的研究念珠菌属的临床分布及其对6种抗真菌药物的敏感性。方法对264株念珠菌属的临床分布进行分析,同时研究264株念珠菌属对两性霉素B、制霉菌素、氟康唑、咪康唑、克霉唑、酮康唑的敏感性。结果264株念珠菌属中,以白色念珠菌最常见占62.5%,其次为热带念珠菌占20.8%、光滑念珠菌占12.5%、近平滑念珠菌占1.9%、其他念珠菌占2.3%;念珠菌属感染的主要部位为肺、泌尿道、消化道;药物敏感试验显示:念珠菌属对制霉菌素、两性霉素B、氟康唑敏感性最高,对唑类药物存在不同程度的耐药。结论应加强对念珠菌属的鉴定及药物敏感性的检测,以指导临床抗感染治疗合理选择药物。     

真菌性阴道炎假丝酵母菌属临床分布及药敏分析

目的探讨真菌性阴道炎假丝酵母菌属临床分布和药敏试验结果。方法回顾性分析1628例阴道炎患者的临床资料,进行真菌培养,药敏试验采用K-B纸片法。结果分离出假丝酵母菌属8种133株,阳性率为8.17%,以白色假丝酵母菌为主占64.66%。假丝酵母菌对特比萘芬的耐药率较高为43.61%、氟康唑为27.82%、伊曲霉唑为21.05%、制霉菌素为3.76%和两性霉素为6.77%。结论真菌性阴道炎感染以白色假丝酵母菌为主,并呈现出多药耐药特点,应根据药敏结果选择合理的抗真菌药物。     

复发性外阴阴道假丝酵母菌病的病原真菌学与耐药性研究

目的了解引起复发性外阴阴道假丝酵母菌病(RVVC)的主要病原菌及其对10种抗真菌药物的耐药性,为临床治疗选择抗真菌药物提供依据。方法将诊断为RVVC的病例阴道分泌物标本,接种予科玛嘉假丝酵母菌显色培养基进行菌种鉴定,采用Rosco纸片扩散法进行药敏试验。结果159例RVVC病例中分离出假丝酵母菌属178株,其中白色假丝酵母菌122株(68.5%)、光滑假丝酵母菌49株(27.5%);122株白色假丝酵母菌敏感性最高的是两性霉素B(100.0%)、克霉唑(100.0%)、制霉菌素(99.2%)、酮康唑(99.2%),最低的是咪康唑(36.9%);56株非白色假丝酵母菌敏感性最高的是制霉菌素(100.0%)、两性霉素B(98.2%)、益康唑(96.4%),最低的是特比萘芬(0)、氟康唑(60.7%)。结论RVVC的主要致病菌是白色假丝酵母菌和光滑假丝酵母菌,非白色假丝酵母菌感染明显上升,在治疗RVVC时必须进行真菌培养和药敏试验,选择敏感药物,在无药敏结果时可选用制霉菌素、酮康唑、克霉唑。     

假丝酵母菌性阴道炎病原菌分布及耐药性分析

目的分析假丝酵母菌性阴道炎的发病情况及耐药性。方法选取假丝酵母菌性阴道炎患者535例,取阴道分泌物进行接种培养,并进行药敏试验。结果 535例假丝酵母菌性阴道炎患者共感染6种真菌,其中白色假丝酵母菌324株,占60.56%,热带假丝酵母菌108株,占20.19%,啤酒假丝酵母菌42株,占7.85%,克柔假丝酵母菌36株,占6.73%;另有光滑假丝酵母菌18株及近平滑假丝酵母菌7株;535株假丝酵母菌属对制霉菌素、两性霉素B以及伊曲康唑耐药性较高,分别为95.51%、94.39%以及81.87%。结论调查假丝酵母菌性阴道炎患者的发病情况,分析感染菌株及其耐药性,对指导临床合理用药、减少耐药菌株产生、取得良好治疗效果有积极意义。     

Non-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance

Non-albicans Candida (NAC) species cause 35-65% of all candidaemias in the general patient population. They occur more frequently in cancer patients, mainly in those with haematological malignancies and bone marrow transplant (BMT) recipients (40-70%), but are less common among intensive care unit (ITU) and surgical patients (35-55%), children (1-35%) or HIV-positive patients (0-33%). The proportion of NAC species among Candida species is increasing: over the two decades to 1990, NAC represented 10-40% of all candidaemias. In contrast, in 1991-1998, they represented 35-65% of all candidaemias. The most common NAC species are C. parapsilosis (20-40% of all Candida species), C. tropicalis (10-30%), C. krusei (10-35%) and C. glabrata (5-40%). Although these four are the most common, at least two other species are emerging: C. lusitaniae causing 2-8% of infections, and C. guilliermondii causing 1-5%. Other NAC species, such as C. rugosa, C. kefyr, C. stellatoidea, C. norvegensis and C. famata are rare, accounting for less than 1% of fungaemias in man. In terms of virulence and pathogenicity, some NAC species appear to be of lower virulence in animal models, yet behave with equal or greater virulence in man, when comparison is made with C. albicans. Mortality due to NAC species is similar to C. albicans, ranging from 15% to 35%. However, there are differences in both overall and attributable mortality among species: the lowest mortality is associated with C. parapsilosis, the highest with C. tropicalis and C. glabrata (40-70%). Other NAC species including C. krusei are associated with similar overall mortality to C. albicans (20-40%). Mortality in NAC species appears to be highest in ITU and surgical patients, and somewhat lower in cancer patients, children and HIV-positive patients. There is no difference between overall and attributable mortality, with the exception of C. glabrata which tends to infect immunocompromised individuals. While the crude mortality is low, attributable mortality (fungaemia-associated mortality) is higher than with C. albicans. There are several specific risk factors for particular NAC species: C. parapsilosis is related to foreign body insertion, neonates and hyperalimentation; C. krusei to azole prophylaxis and along with C. tropicalis to neutropenia and BMT; C. glabrata to azole prophylaxis, surgery and urinary or vascular catheters; C. lusitaniae and C. guilliermondii to previous polyene (amphotericin B or nystatin) use; and C. rugosa to burns. Antifungal susceptibility varies significantly in contrast to C. albicans: some NAC species are inherently or secondarily resistant to fluconazole; for example, 75% of C. krusei isolates, 35% of C. glabrata, 10-25% of C. tropicalis and C. lusitaniae. Amphotericin B resistance is also seen in a small proportion: 5-20% of C. lusitaniae and C. rugosa, 10-15% of C. krusei and 5-10% of C. guilliermondii. Other NAC species are akin to C. albicans-susceptible to both azoles and polyenes (C. parapsilosis, the majority of C. guilliermondii strains and C. tropicalis). Therefore, 'species directed' therapy should be administered for fungaemia according to the species identified-amphotericin B for C. krusei and C. glabrata, fluconazole for other species, including polyene-resistant or tolerant Candida species (C. lusitaniae, C. guilliermondii). In vitro susceptibility testing should be performed for most species of NAC in addition to removal of any foreign body to optimize management.