念珠菌的临床分布与耐药性分析

目的:调查住院患者近期念珠菌感染的临床分布及耐药性,为临床合理使用抗真菌药物提供科学依据。方法:对1217例住院患者采用显色培养法及ATBTM FUNGUS3真菌药敏试验板进行念珠菌的药敏试验。结果:临床分离到1217株念珠菌,其中白色念珠菌598株(49.14%),非白色念珠菌619株(50.86%),非白色念珠菌中检出最多的是光滑念珠菌、热带念珠菌和克柔念珠菌,分别为264株(21.69%)、239株(19.64%)和57株(4.68%);检出念珠菌最多的部位是呼吸道,占全部标本的77.98%(949例);其次为泌尿道占10.44%(127例),粪便占9.61%(117例)。体外药敏试验结果显示白念珠菌、光滑念珠菌、热带念珠菌、克柔念珠菌、近平滑念珠菌中对5-氟胞嘧啶(5-FC)、两性霉素B(AMB)、伏立康唑(VRC)的敏感性除克柔念珠菌对5-FC、AMB的敏感率为38.96%、89.70%外,其它念珠菌都有较高的敏感性,对氟康唑(FCA)、伊曲康唑(ITR)药敏试验结果显示除克柔念珠菌对FCA天然耐药外,光滑念珠菌、克柔念珠菌等存在不同程度的耐药性或剂量依赖性敏感(SDD)。结论:目前医院真菌感染仍然以念珠菌感染为主,其中白色念珠菌虽然占主要地位,但非白色念珠菌明显增加,主要为克柔念珠菌、热带念珠菌和光滑念珠菌,同时,已出现不同程度的对抗真菌药物的耐药,并有增加的趋势。

Clinical distribution and drug resistance of candida infection

Objective: To study the clinical distribution and drug resistance of fungus in our hospital and to provide a scientific theory to use anti-fungus. Methods: Fungus were identified by chomargar medium and ATB Fungus 3 were used for susceptibility test. Results: There were 1 217 elderly candida, Candida albicans were 598 strains(49.14%), non Candida albicans 619 strains(50.8614%); in non Candida albicans, the 3 most were Candida glabrata, Candida tropicalis, Candida krusei, and the proportion were 21.69%(264 strains), 19.64%(239 strains), 4.68%(57 strains)respectively. The position where isolated were the most was respiratory tract 77.98%(949 cases), then urinary tract 10.44%(127 cases), stool 9.61%(117 cases). The susceptibility test show Candida albicans, Candida glabrata, Candida tropicalis and Candida parapsilosis had high susceptibility rate to 5FC, AMB, VRC, But the susceptibility of Candida.krusei to 5FC, AMB were 38.90%, 89.70% respectively. To FCA, ITR, Candida glabrata, Candida krusei have some resistant rate and SDD. Conclusions: Nowadays the fungus in clinic were mostly candida, and Candida albicans has the highest isolation rate, and non Candida albicans were more than before, the maior were Candida krusei, Candida tropicali, Candida glabrata, at the same time the resistant rate to anti-fungus were higher than before.