351株甲真菌病病原菌临床分布及体外药敏试验

 目的 了解海南省甲真菌病病原菌的分布以及菌株对临床常用抗真菌药物的敏感情况。方法 收集2016年5月-2018年11月某院就诊的甲真菌病患者甲屑标本，通过培养、鉴定以及体外药敏试验，对检出的真菌菌株进行分析。结果 共收集甲真菌病患者348例，检出病原菌351株。病原菌以酵母样菌属为主（53.28%），其中优势菌为近平滑假丝酵母菌（22.22%）和白假丝酵母菌（11.40%）；其次是皮肤癣菌属（29.63%），其中优势菌为红色毛癣菌（25.07%）。检出病原菌的患者年龄段主要集中在21~30岁（86株）、31~40岁（77株）、41~50岁（49株）；患者男女比例1：1.52。甲真菌病患者临床分型主要为以远端侧缘甲下型（47.41%）、浅表白甲型（18.97%）、全甲破坏型（15.80%）为主。红色毛癣菌和指（趾）间毛癣菌对特比萘芬的MIC几何均数最低，茄病镰刀菌对伏立康唑的MIC几何均数最低，假丝酵母菌（白假丝酵母菌、近平滑假丝酵母菌、热带假丝酵母菌、都柏林假丝酵母菌）对酮康唑、伊曲康唑、伏立康唑的MIC几何均数均较低。结论 海南岛2016-2018年甲真菌病病原菌以酵母样菌属为主，由其引起的甲真菌病可首选酮康唑、伊曲康唑、伏立康唑。

Clinical distribution and in vitro drug susceptibility testing of 351 strains of onychomycosis pathogens

Objective To investigate the distribution of onychomycosis pathogens and susceptibility of pathogens to commonly used antifungal agents in Hainan Province. Methods Nail scrap specimens of patients with onychomycosis in a hospital from May 2016 to November 2018 were collected, isolated fungal strains were analyzed by culture, identification and in vitro antifungal susceptibility testing. Results A total of 348 patients with onychomycosis were collected, 351 strains of pathogens were isolated. The main pathogens were yeast-like fungi (53.28%), dominantly Candida parapsilosis (22.22%) and Candida albicans (11.40%), followed by Dermatophytes (29.63%), dominantly Trichophyton rubrum (25.07%). Fungal strains were mainly isolated from patients in age groups of 21-30 years old (86 strains), 31-40 years old (77 strains) and 41-50 years old (49 strains); the ratio of male to female patients was 1:1.52. The main clinical types of onychomycosis were distal lateral subungual onychomycosis (47.41%), superficial white onychomycosis(18.97%), and total dystrophic onychomycosis(15.80%). Geometric mean of MIC of Trichophyton rubrum and Trichophyton interdigitale to terbinafine was the lowest, geometric mean of MIC of Fusarium solani to vriconazole was the lowest, geometric mean of MIC of Candida (Candida albicans, Candida parapsilosis, Candida tropicalis, and Candida dubliniensis) to ketoconazole, itraconazole, and vriconazole were all low. Conclusion The main pathogen of onychomycosis in Hainan Province from 2016 to 2018 are yeast-like fungi, ketoconazole, itraconazole and voriconazole are preferred for treatment of onychomycosis.