婴幼儿皮肤念珠菌病的致病菌株及药敏试验分析

目的 分析婴幼儿皮肤念珠菌病的致病菌种类及对抗真菌药物的敏感性。方法 收集皮肤念珠菌病患儿病例，对临床分离的致病菌进行常规菌种鉴定，采用琼脂稀释法（药基法）对临床分离的念珠菌进行6种药物（氟康唑、咪康唑、联苯苄唑、益康唑、克霉唑、制霉菌素）敏感性试验，选取9株白念珠菌临床菌株和1株白念珠菌标准菌株，参考NCCLS M27-A推荐的微量液体稀释法界定琼脂稀释法的药敏分界点，分析耐药性。结果 共收集75例皮肤念珠菌病病例，分离到的88株念珠菌均为白念珠菌，用琼脂稀释法所测的MIC范围是：氟康唑1 ～ 256 mg/L，咪康唑0.25 ～ 64 mg/L，联苯苄唑0.5 ～ 64 mg/L，益康唑0.25 ～ 32 mg/L，克霉唑1 ～ 64 mg/L，制霉菌素0.5 ～ 32 mg/L。临床株对唑类药物均有耐药株出现，氟康唑1株，克霉唑4株，益康唑3株，咪康唑5株，联苯苄唑9株。结论 婴幼儿皮肤念珠菌病主要由白念珠菌引起；白念珠菌对5种唑类药物均有耐药株出现，且有交叉耐药现象，对制霉菌素敏感。

Species profile and anti-yeast susceptibility of pathogenic fungi isolated from infants and young childzen with dermatoeandidiasis

Objective To explore the species profile and anti-yeast susceptibility of pathogenic yeast isolated from infants and young children with dermatocandidiasis. Methods Yeast strains were isolated from infants and young children with dermatocandidiasis, and identified with routine methods. Agar dilution test was used to determine the susceptibility of fungal isolates to fluconazole, miconazole, bifonazole, econazole, clotrimazole and nystatin. The breakpoint for antifungal resistance was established according to the MICs resulted from microdilution test recommended by NCCLS M27-A. Resistance is considered to occur when the MIC determined by agar dilution test is 4 or more folds higher than the breakpoint MIC determined by microdilution test. Results A total of 75 cases of dermatocandidiasis were collected, and 88 strains of yeast were isolated; they were consistently identified as Candida albicans . Agar dilution test showed that: the MIC was 1 - 256 mg/L for fluconazole, 0.25 - 64 mg/L for miconazole, 0.5 - 64 mg/L for bifonazole, 0.25 - 32 mg/L for econazole, 1 - 64 mg/L for clotrimazole, 0.5 - 32 mg/L for nystatin. All the C. albicans isolates were susceptible to nystatin, while resistance to fluconazole, clotrimazole, econazole, miconazole and bifonazole was observed in 1, 4, 3, 5 and 9 C. albicans strains respectively. Conclusions C. albicans is the most predominant species causing dermatocandidiasis in infants and young children. Resistance is observed to fluconazole, miconazole, bifonazole, econazole and clotrimazole in some isolates of C. albicans along with cross-resistance. However, all isolates are susceptible to nystatin.