2015～2017年某医院念珠菌感染及其耐药性分析
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摘要
目的分析院内常见念珠菌感染的种类、分布及耐药情况,为临床医师合理用药方案提供一定依据。方法收集2015-2017年间甘肃中医药大学附属医院临床分离的720株念珠菌的相关资料,对其菌种分布及其对氟康唑、伊曲康唑、伏立康唑、两性霉素B及5-氟胞嘧啶的耐药情况进行回顾性分析。结果 720例念珠菌感染病例中,科室分布以老年病及肺病科为主,感染来源以下呼吸道感染为主。分离株以白念珠菌为主,其次为热带念珠菌和近平滑念珠菌;3年间菌种分布构成比差异无统计学意义(P=0.097)。白念珠菌对氟康唑、伏立康唑、伊曲康唑及两性霉素B的耐药性显著低于非白念珠菌(P<0.001),所有念珠菌对5-氟胞嘧啶均高度敏感,差异无统计学意义(P=0.217)。720株念珠菌中共有102例多重耐药株,其中以光滑念珠菌和克柔念珠菌的多重耐药率最高。5种抗真菌药物耐药率均显著正相关(P<0.001),其中以氟康唑和伏立康唑相关性最强(r=0.828)。结论白念珠菌仍为院内感染的主要分离念珠菌,3年间分离率无明显变化;白念珠菌与非白念珠菌耐药性差异较大,且非白念珠菌多重耐药率较高,临床用药时应合理选择抗真菌药物治疗。
Objective To explore the species distribution and drug resisitance of Candida infection in our hospital from Jan. 2015 to Dec. 2017, and to provide etiological basis for clinical rational use of antifungal agents. Method All the data of patients with Candida infection including gender, age, organism, specimen type, department distribution and drug residence from Jan. 2015 to Dec were retrospectively collected. Result Total 720 Candida isolates mainly came from Geriatric department and Pulmonary department. C. albicans was the most common one, followed by C. tropicalis and C. parapsilosis. The main site of infection was respiratory tracts. There was no difference in the distributions of species from 2015 to 2017. The resistance of Candida albicans to fluconazole, voriconazole, itraconazole and amphotericin B was lower than that of non-Candida albicans(P<0.001). There were 102 multi-drug resistant strains in 720 Candida isolates, among which C. glabrata and C.krusei had the highest multi-drug resistance rates. Conclusion Candida albicans was still the main isolate of Candida, and there is no significant change in the isolation rates during three years; the drug resistance of Candida albicans and non-Candida albicans was different, and the multi-drug resistance rate of non-Candida albicans was higher than that of C. albicans. Clinical antifungal therapy should be based on the results of antifungal susceptibility test.
Objective To explore the species distribution and drug resisitance of Candida infection in our hospital from Jan. 2015 to Dec. 2017, and to provide etiological basis for clinical rational use of antifungal agents. Method All the data of patients with Candida infection including gender, age, organism, specimen type, department distribution and drug residence from Jan. 2015 to Dec were retrospectively collected. Result Total 720 Candida isolates mainly came from Geriatric department and Pulmonary department. C. albicans was the most common one, followed by C. tropicalis and C. parapsilosis. The main site of infection was respiratory tracts. There was no difference in the distributions of species from 2015 to 2017. The resistance of Candida albicans to fluconazole, voriconazole, itraconazole and amphotericin B was lower than that of non-Candida albicans(P<0.001). There were 102 multi-drug resistant strains in 720 Candida isolates, among which C. glabrata and C.krusei had the highest multi-drug resistance rates. Conclusion Candida albicans was still the main isolate of Candida, and there is no significant change in the isolation rates during three years; the drug resistance of Candida albicans and non-Candida albicans was different, and the multi-drug resistance rate of non-Candida albicans was higher than that of C. albicans. Clinical antifungal therapy should be based on the results of antifungal susceptibility test.
引文
[1] 施伟民, 伍洲炜, 潘炜华,等. 念珠菌病的诊断和治疗进展[J]. 世界临床药物, 2010, 31(12):705-711.
[2] 杨丰帅, 周厚吾. 白色念珠菌致病机制及治疗研究进展[J]. 现代医药卫生, 2013, 29(22):3411-3414.
[3] Denning DW, Muňoz P. Advances in invasive fungal infection and antifungal therapy: Introduction[J]. Clin Microbiol Infect, 2001,7(Suppl2):vi.DOI: https://doi.org/10.1111/j.1469-0691.2001.tb00003.x.
[4] 廖万清, 顾菊林. 深部真菌感染治疗的现状与对策[J]. 中国感染与化疗杂志, 2007, 7(2):101-103.
[5] Correia A, Sampaio P J,Pais C. Study of molecular epidemiology of candidiasis in portugal by PCR fingerprinting of Candida clinical isolates[J]. J Clin Microbiol, 2004, 42(12):5899.
[6] 傅庆萍, 梅亚宁, 陈友华. 1015株念珠菌感染的病原菌分类和药敏分析[J]. 中华医院感染学杂志, 2005, 15(11):116-117.
[7] 顾兵, 梅亚宁, 潘世扬,等. 2008年南京医科大学第一附属医院细菌及真菌耐药性监测[J]. 中国抗生素杂志, 2010, 35(9):688-694.
[8] Sanguinetti M ,Posteraro B , LassFl?rl, C. Antifungal drug resistance among Candida species: mechanisms and clinical impact[J]. Mycoses, 2015, 58(S2):2-13.
[9] 李绍红. 呼吸内科念珠菌感染的特点和耐药性研究[J]. 山西医药杂志, 2007, 36(12):1145-1146.
[10] 杨莉莉, 范严严, 邓英,等. 146株念珠菌的分布及药敏结果分析[J]. 中华医院感染学杂志, 2004, 14(6):703-704.
[11] Pendleton KM ,Huffnagle GB , Dickson RP . The significance of Candida in the human respiratory tract: our evolving understanding[J]. Pathogens and Disease, 2017, 75(3).
[12] 李从荣,彭少华,李栋,等.深部真菌医院感染的临床调查与耐药现状研究[J].中华医院感染学杂志,2002,12(7):485-487.
[13] Vermes A. 氟胞嘧啶的毒性与药物动力学参数间的相关性[J]. 国外医药(抗生素分册), 2000,21(5):240-241.
[14] 顾迟, 陈功祥, 周宏伟. 念珠菌对唑类药物耐药性及耐药机制的研究进展[J]. 临床药物治疗杂志, 2010, 8(3):44-48.
[15] 叶枫, 钟淑卿, 袁锦屏,等. 呼吸病区下呼吸道分离念珠菌的耐药性监测[J]. 中华结核和呼吸杂志, 2009, 32(9):707-709.
[16] 彭丽娟, 胡妮娅, 杜经纬,等. 医院患者深部真菌感染的临床分布与耐药性分析[J]. 中华医院感染学杂志, 2015, 25(22):5122-5124.
[17] Rocco TR,Reinert SE, Simms HH. Effects of fluconazole administration in critically ill patients: analysis of bacterial and fungal resistance.[J]. Archives of Surgery, 2000, 135(2):160.
[18] 王彬, 魏曼, 方华,等. 念珠菌耐药机制研究新进展[J]. 中国病原生物学杂志, 2014(5):473-477.
[2] 杨丰帅, 周厚吾. 白色念珠菌致病机制及治疗研究进展[J]. 现代医药卫生, 2013, 29(22):3411-3414.
[3] Denning DW, Muňoz P. Advances in invasive fungal infection and antifungal therapy: Introduction[J]. Clin Microbiol Infect, 2001,7(Suppl2):vi.DOI: https://doi.org/10.1111/j.1469-0691.2001.tb00003.x.
[4] 廖万清, 顾菊林. 深部真菌感染治疗的现状与对策[J]. 中国感染与化疗杂志, 2007, 7(2):101-103.
[5] Correia A, Sampaio P J,Pais C. Study of molecular epidemiology of candidiasis in portugal by PCR fingerprinting of Candida clinical isolates[J]. J Clin Microbiol, 2004, 42(12):5899.
[6] 傅庆萍, 梅亚宁, 陈友华. 1015株念珠菌感染的病原菌分类和药敏分析[J]. 中华医院感染学杂志, 2005, 15(11):116-117.
[7] 顾兵, 梅亚宁, 潘世扬,等. 2008年南京医科大学第一附属医院细菌及真菌耐药性监测[J]. 中国抗生素杂志, 2010, 35(9):688-694.
[8] Sanguinetti M ,Posteraro B , LassFl?rl, C. Antifungal drug resistance among Candida species: mechanisms and clinical impact[J]. Mycoses, 2015, 58(S2):2-13.
[9] 李绍红. 呼吸内科念珠菌感染的特点和耐药性研究[J]. 山西医药杂志, 2007, 36(12):1145-1146.
[10] 杨莉莉, 范严严, 邓英,等. 146株念珠菌的分布及药敏结果分析[J]. 中华医院感染学杂志, 2004, 14(6):703-704.
[11] Pendleton KM ,Huffnagle GB , Dickson RP . The significance of Candida in the human respiratory tract: our evolving understanding[J]. Pathogens and Disease, 2017, 75(3).
[12] 李从荣,彭少华,李栋,等.深部真菌医院感染的临床调查与耐药现状研究[J].中华医院感染学杂志,2002,12(7):485-487.
[13] Vermes A. 氟胞嘧啶的毒性与药物动力学参数间的相关性[J]. 国外医药(抗生素分册), 2000,21(5):240-241.
[14] 顾迟, 陈功祥, 周宏伟. 念珠菌对唑类药物耐药性及耐药机制的研究进展[J]. 临床药物治疗杂志, 2010, 8(3):44-48.
[15] 叶枫, 钟淑卿, 袁锦屏,等. 呼吸病区下呼吸道分离念珠菌的耐药性监测[J]. 中华结核和呼吸杂志, 2009, 32(9):707-709.
[16] 彭丽娟, 胡妮娅, 杜经纬,等. 医院患者深部真菌感染的临床分布与耐药性分析[J]. 中华医院感染学杂志, 2015, 25(22):5122-5124.
[17] Rocco TR,Reinert SE, Simms HH. Effects of fluconazole administration in critically ill patients: analysis of bacterial and fungal resistance.[J]. Archives of Surgery, 2000, 135(2):160.
[18] 王彬, 魏曼, 方华,等. 念珠菌耐药机制研究新进展[J]. 中国病原生物学杂志, 2014(5):473-477.