正常阴道乳杆菌对6种常见抗真菌药物的体外敏感性

目的了解正常阴道乳杆菌对临床6种常用抗真菌药物的敏感性。方法选取于2009年8月至11月在北京大学第一医院妇产科门诊就诊的健康体检无阴道感染患者100例,取患者阴道分泌物,分离鉴定乳杆菌37例。应用药敏纸片法对不同抗真菌药物进行体外药物敏感性试验。结果阴道正常乳杆菌对克霉唑、氟康唑、咪康唑、伊曲康唑、制霉菌素和特比萘芬6种抗真菌药的敏感率(0～3.8%)均较低,耐药率92.3%～100%,各组间比较,差异无统计学意义(P0.05)。乳杆菌对头孢呋辛(阴性对照组)的耐药率为89.2%,与各抗真菌药组比较,差异均有统计学意义(P0.001)。乳杆菌对左氧氟沙星(阳性对照组)的敏感率(8.1%)较低,与各抗真菌药物组比较,差异均无统计学意义(P0.05)。结论常用6种抗真菌药物在有效抑制阴道假丝酵母菌的同时,对阴道正常乳杆菌的生存无明显影响。在临床外阴阴道假丝酵母菌病的治疗中,可以尝试同时应用抗真菌药和乳杆菌活菌制剂。

The drug susceptibility in vitro of normal vaginal Lactobacillus to six different antifungal drugs

Objective To investigate the susceptibility of normal vaginal Lactobacillus to six commonly used antifungal drugs.Methods 100 outpatients without vaginal infection were recruited randomly and their vaginal secretion were obtained in the Peking University First Hospital from August 2009 to Nevember 2009.Isolation and identification of Lactobacillus were processed in 37 cases.The disk diffusion method was used for susceptibility testing in vitro with six kinds of antifungal drugs.Results The sensitivity rates of lactobacillus to the six antifungal drugs（Clotrimazole,Fluconazole,Miconazole,Itraconazole,Nystatin and Terbinafine） were low（0～3.8%）,while the drug-resistant rate were 92.3% to 100% and there were no significant difference between each two groups（P〉0.05）.In the positive control group,Lactobacillus shows a high drug-resistant rate（89.2%） to Cefuroxime,significant difference compared with each antifungal drug group（P〈0.001）.In another control group,Lactobacillus shows a low sensitivity（8.1%） to Levofloxacin（negative control）,and there was no significant difference between the Levofloxacin group and other antifungal drugs groups（P〉0.05）.Conclusions The six commonly used antifungal drugs have no obvious effect on the survival of normal vaginal Lactobacillus,while they inhibit vaginal candida obviously.So combined Lactobacillus preparations with antifungal drugs maybe an effective treatment for VVC.