497例临床假丝酵母菌菌种分布及耐药性分析

摘要/Abstract

摘要：

目的了解沈阳地区住院患者标本中分离出假丝酵母菌感染的类型、分布及耐药情况，为指导临床预防假丝酵母菌感染及合理用药提供理论依据。方法回顾性收集中国医科大学附属盛京医院2015~2018年住院患者送检标本中分离出假丝酵母菌菌株的临床资料，统计菌株鉴定及药敏实验数据及结果。结果共检出假丝酵母菌497株，其中以近平滑假丝酵母菌为主（175，35.2%），其次依次为白假丝酵母菌（127，25.6%）、菌膜假丝酵母菌（51，10.3%）、光滑假丝酵母菌（42，8.5%）和热带假丝酵母菌（36，7.2%），菌种分布存在统计学差异（P=0.004）；菌株宿主主要来源于0~9岁及50~69岁年龄段患者；检出标本来源以血液标本最多（405，81.5%），胸腹水（21，4.2%）和引流液（21，4.2%）次之，不同标本类型之间菌株分布有统计学差异（P=0.003）；临床常见假丝酵母菌对氟康唑（FLU）、伏立康唑（VRC）、氟胞嘧啶（FC）、伊曲康唑（ITR）和两性霉素B（Amb）的耐药率分别为3.0%、2.2%、4.0%、5.0%和4.0%。结论院内假丝酵母菌感染以近平滑假丝酵母菌最为常见。在治疗新生儿、老年患者和消化系统疾病患者，要警惕发生假丝酵母菌的二重感染。

关键词: 假丝酵母菌, 药敏实验, 耐药性

Abstract:

Objective To explore the type, distribution and drug resistance of inpatient's Candida infection in Shenyang, so as to provide theoretical basis for clinical prevention and rational drug use of Candida infection. Methods The clinical data of Candida strains isolated from inpatients in Sheng Jing Hospital affiliated to China Medical University from 2015 to 2018 were collected retrospectively, and the data and results of strain identification and drug sensitivity test were statistically analyzed. Results A total of 497 strains of Candida were detected, of which the main strains were Candida parapsilosis (175, 35.2%), followed by Candida albicans (127, 25.6%), Candida pelliculosa (51, 10.3%), Candida glabrata (42, 8.5%) and Candida tropicalis (36, 7.2%). The distribution of the strains was statistically different (P=0.004). The hosts were mainly of patients aged 0-9 and 50-69 years old. In 497 strains of Candida, the isolates of from blood was accounted for 81.5%,followed by those from hydrothorax or ascitic fluid (4.2%), drainage fluid (4.2%) cerebrospinal fluid (1.4%) and urine were (1.4%). There was significant difference in the distribution of strains among different types of samples (P=0.003). The resistance rates of clinical common Candida to fluconazole, voriconazole, flucytosine, itraconazole, and amphotericin B were 3.0%, 2.2%, 4.0%, 5.0% and 4.0%, respectively. Conclusion The infection of Candida albicans in hospital was the most common. In the treatment of newborns, elderly patients and patients with digestive system diseases, we should be alert to the occurrence of double infection of Candida.

Key words: Candida, drug sensitivity test, drug resistance

中图分类号:

R519.3

王俊庭, 刘勇. 497例临床假丝酵母菌菌种分布及耐药性分析[J]. 中国真菌学杂志, 2020, 15(2): 78-82.

WANG Jun-ting, LIU Yong. Analysis of distribution and drug resistance of clinical Candida strains in 497 cases[J]. Chinese Journal of Mycology, 2020, 15(2): 78-82.

参考文献

[1] Esher SK, Fidel PL Jr, Noverr MC. Candida/Staphylococcal polymicrobial intra-abdominal infection:pathogenesis and perspectives for a novel form of trained innate immunity[J]. J Fungi (Basel), 2019, 5(2).doi:10.3390/jof5020037
[2] Yang L, Su MQ, Ma YY, et al. Epidemiology, species distribution, antifungal susceptibility, and ERG11 mutations of Candida species isolated from pregnant Chinese Han women[J]. Genet Mol Res, 2016, 15(2). doi:10.4238/gmr.15027168.
[3] Caggiano G, Coretti C, Bartolomeo N, et al. Candida bloodstream infections in Italy:changing epidemiology during 16 years of surveillance[J]. Biomed Res Int, 2015, 2015:256580.
[4] Noni M, Stathi A, Vaki I, et al. Changing epidemiology of invasive candidiasis in children during a 10-year period[J]. J Fungi (Basel), 2019, 5(1):E19. doi:10.3390/jof5010019.
[5] Pappas PG, Kauffman CA, Andes DR, et al. Executive summary:Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 62(4):409-417.
[6] Da Matta DA, Souza ACR, Colombo AL. Revisiting species distribution and antifungal susceptibility of Candida bloodstream isolates from Latin American Medical Centers[J]. J Fungi (Basel), 2017, 3(2):E24. doi:10.3390/jof3020024.
[7] Xiao Z, Wang Q, Zhu F, et al. Epidemiology, species distribution, antifungal susceptibility and mortality risk factors of candidemia among critically ill patients:a retrospective study from 2011 to 2017 in a teaching hospital in China[J]. Antimicrob Resist Infect Control, 2019, 8:89.
[8] Wu PF, Liu WL, Hsieh MH, et al. Epidemiology and antifungal susceptibility of candidemia isolates of non-albicans Candida species from cancer patients[J]. Emerg Microbes Infect, 2017, 6(10):e87.
[9] Almooosa Z, Ahmed GY, Omran A, et al. Invasive candidiasis in pediatric patients at King Fahad Medical City in Central Saudi Arabia. A 5-year retrospective study[J]. Saudi Med J, 2017, 38(11):1118-1124.
[10] 卢岩, 张秀月, 施红, 等. 新生儿菌膜假丝酵母菌感染分析及干预评价[J]. 中华医院感染学杂志, 2013, 23(20):4964-4966.
[11] Rodriguez L, Bustamante B, Huaroto L, et al. A multi-centric study of Candida bloodstream infection in Lima-Callao, Peru:Species distribution, antifungal resistance and clinical outcomes[J]. PLoS One, 2017, 12(4):e0175172.
[12] Bhattacharjee P. Epidemiology and antifungal susceptibility of Candida species in a tertiary care hospital, Kolkata, India[J]. Curr Med Mycol, 2016, 2(2):20-27.
[13] 曹凤林, 毕铮铮, 谷光宇, 等. 老年糖尿病患者医院感染真菌性肺炎临床分析[J]. 中华医院感染学杂志, 2010, 20(7):959-961.
[14] Xiao M, Sun ZY, Kang M, et al. Five-year national surveillance of invasive candidiasis:species distribution and azole susceptibility from the China Hospital Invasive Fungal Surveillance Net (CHIF-NET)study[J]. J Clin Microbiol, 2018, 56(7):e00577-18. doi:10.1128/JCM.00577-18.
[15] 荣辰, 田素飞, 褚云卓. 326株念珠菌血症病原菌种分布和药敏结果分析[J]. 中国医科大学学报, 2018, 47(9):773-777.
[16] 邓琳, 孔庆涛, 陈军, 等. 1135株临床念珠菌分布特征和药敏结果分析[J]. 中国真菌学杂志, 2016, 11(3):160-165.
[17] 王剑荣, 刘长文, 朱克毅, 等. ICU真菌种类及耐药情况分析[J]. 浙江中西医结合杂志, 2013(4):330-332.
[18] 陈永红, 苏文霞, 陈中举, 等. 真菌血症患者临床特点及真菌分析[J]. 中华医院感染学杂志, 2014, 24(5):1118-1120.