院内念珠菌血液感染的菌种分布及药敏分析
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摘要
目的分析我院念珠菌血液感染的菌种比例、科室分布和体外药敏情况,为临床抗真菌药物的选择提供支持。方法回顾性分析无锡市第二人民医院在2013~2016年间血培养结果为念珠菌的病例,统计菌种分布及药敏结果等。结果血培养标本中念珠菌阳性病例共有56例,其中白念珠菌比例为57%(32/56),非白念珠菌占43%(24/56)。非白念珠菌菌株主要为近平滑念珠菌(20%,11/56)和光滑念珠菌(15.8%,9/56)。念珠菌感染病例主要分布在重症监护科(23.2%,13/56)和肾内科(17.9%,10/56)。白念珠菌与非白念珠菌对临床最常用的抗真菌药物氟康唑的敏感率差别最大,分别为93.8%和62.5%;56株念珠菌菌株对抗真菌药物两性霉素B和5-氟尿嘧啶的敏感性均为100%;55.6%的光滑念珠菌和72.7%的近平滑念珠菌对氟康唑敏感,所有克柔念珠菌株对氟康唑均耐药。结论本院近几年念珠菌血液感染的病原菌仍以白念珠菌为主,但非白念珠菌对一线抗真菌药物氟康唑的耐药性更高,临床上抗真菌的药物选择应充分考虑耐药问题。
Objective To investigate the pathogen distribution and drug resistance of Candida bloodstream infection.Methods The data of Candidaisolated from blood culture were retrospectively analyzed in the Wuxi No.2 People's Hospital from 2013 to 2016.Results Fifty-six pathogenic Candida strains were isolated,which included Candida albicans(57%,32/56),Candida parapsilosis(20%,11/56)and Candida glabrata(15.8%,9/56).The patients mainly came from the ICU(23.2%,13/56)and the department of Nephrology(17.9%,10/56).The difference of sensitivity rates between Candida albicans and non-albicans candida was notable,which were 93.8% and 62.5%.The sensitivity rates of 56 Candida strains to amphotericin B and flucytosine were 100%.The sensitivity rates of Candida glabrataand Candida parapsilosis to fluconazole were 55.6% and 72.7%.All the Candida krusi strains were resistance to fluconazole.Conclusions The main pathogenic Candidaisolated from bloodstream infection was Candida albicans.The sensitivity tests showed that non-albicans candida species had relatively strong endurance to fluconazole.Therefore,drug resistance should be considered in the selection of antifungal drugs.
Objective To investigate the pathogen distribution and drug resistance of Candida bloodstream infection.Methods The data of Candidaisolated from blood culture were retrospectively analyzed in the Wuxi No.2 People's Hospital from 2013 to 2016.Results Fifty-six pathogenic Candida strains were isolated,which included Candida albicans(57%,32/56),Candida parapsilosis(20%,11/56)and Candida glabrata(15.8%,9/56).The patients mainly came from the ICU(23.2%,13/56)and the department of Nephrology(17.9%,10/56).The difference of sensitivity rates between Candida albicans and non-albicans candida was notable,which were 93.8% and 62.5%.The sensitivity rates of 56 Candida strains to amphotericin B and flucytosine were 100%.The sensitivity rates of Candida glabrataand Candida parapsilosis to fluconazole were 55.6% and 72.7%.All the Candida krusi strains were resistance to fluconazole.Conclusions The main pathogenic Candidaisolated from bloodstream infection was Candida albicans.The sensitivity tests showed that non-albicans candida species had relatively strong endurance to fluconazole.Therefore,drug resistance should be considered in the selection of antifungal drugs.
引文
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[12]Guimares LF,Halpern M,de LemosAS,et al.Invasive fungal disease in renal transplant recipients at a Brazilian center:Local epidemiology matters[J].Transplant Proc,2016,48(7):2306-2309.
[2]Kullberg BJ,Arendrup MC.Invasive candidiasis[J].N Engl J Med,2015,373(8):1445-1456.
[3]Lewis JS,Wiederhold NP,Wickes BL,et al.Rapid emergence of echinocandin resistance in Candida glabrata resulting in clinical and microbiologic failure[J].Antimicrob Agents Chemother,2013,57(9):4559-4561.
[4]Wayne PA.Reference method for broth dilution antifungal susceptibility testing of yeasts,approved standard M27-A3[M].Clinical and Laboratory Standards Institute,2008.
[5]阚思玥,李筱芳,刘维达.人类念珠菌感染的基因易感性[J].中国真菌学杂志,2017,12(2):120-123.
[6]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.
[7]Phoompoung P,Chayakulkeeree M.Recent progress in the diagnosis of pathogenic Candida species in blood culture[J].Mycopathologia,2016,181(5-6):363-369.
[8]Arendrup MC.Update on antifungal resistance in Aspergillus and Candida[J].Clin Microbiol Infect,2014,20(s6):42-48.
[9]Jensen RH,Johansen HK,Ses LM,et al.Posttreatment antifungal resistance among colonizing Candida isolates in candidemia patients:results from a systematic multicenter study[J].Antimicrob Agents Chemother,2015,60(3):1500-1508.
[10]Pappas PG,Kauffman CA,Andes D,et al.Clinical practice guidelines for the management of candidiasis:2009update by the Infectious Diseases Society of America[J].Clin Infect Dis,2009,48(5):503-535.
[11]Snigdha V,Cleveland AA,Farley MM,et al.Epidemiology and risk Factors for echinocandin nonsusceptible Candida glabrata bloodstream infections:Data from a large multisite population-based candidemia surveillance program,2008-2014[J].Open Forum Infect Dis,2015,2(4):ofv163.
[12]Guimares LF,Halpern M,de LemosAS,et al.Invasive fungal disease in renal transplant recipients at a Brazilian center:Local epidemiology matters[J].Transplant Proc,2016,48(7):2306-2309.