某医院急诊科住院患者口腔酵母菌分离鉴定及耐药性分析
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摘要
目的了解急诊科住院患者口腔酵母菌的种类分布情况及其药物敏感性,为临床预防真菌感染及合理用药提供依据。方法用常规棉拭子法采集2015-2016年海南省人民医院急诊科352例住院患者口腔黏膜标本进行真菌分离培养、科玛嘉显色及ITS鉴定,分析不同疾病、年龄段患者酵母菌的检出情况,并进行体外两性霉素B、氟康唑、酮康唑、伊曲康唑及氟胞嘧啶纸片法药敏测定。结果 352例住院患者口腔标本中,241例(68.8%)口腔携带酵母菌,其中8例患者携带2种以上菌株,60岁以上患者分离率显著高于60岁以下患者(P<0.05);共分离到10种酵母菌共250株,包括白假丝酵母菌134株,光滑假丝酵母菌61株,热带假丝酵母菌28株,克柔假丝酵母菌13株,其他14株。体外5种抗真菌药物敏感性分析发现,两性霉素B的耐药率为2.0%,氟康唑的耐药率为20.4%,伊曲康唑的耐药率为19.6%,酮康唑的耐药率为11.6%,氟胞嘧啶的耐药率为8.4%。结论急诊科住院患者口腔酵母分离率高,且对临床常见的5种抗真菌药物存在不同的耐药率,尤其是唑类药物存在较高的耐药率。
Objective To investigate the distribution of oral yeasts and their drug sensitivity in hospitalized patients from emergency department for clinical prevention of fungal infection and rational use of drugs. Methods Oral examination and microbial swabs were obtained from hospitalized patients from emergency department of Hainan Province from 2015 to 2016.In order to reveal the prevalence of yeast colonization by isolation and cultivation of fungi, and to detect its susceptibility to amphotericin B, fluconazole, ketoconazole, itraconazole and flucytosine. Results Among the 352 oral swabs, 241(68.8%)tested positive to contain yeasts, and 8 carried more than 2 strains. The prevalence of yeast colonization was significant higher among those over 60 years old compared with their younger counterparts(P<0.05). 250 strains of yeast belong to 10 species were isolated from the oral cavity of 241 inpatients, including 134 strains of Candida albicans, 61 strains of Candida glabrata,28 strains of Candida tropicalis, 13 strains of Candida krusei, and 14 other strains. The antifungal drugs susceptibility analysis found that the resistance rate to amphotericin B, fluconazole, itraconazole, ketoconazole and flucytosine were 2%,20.4%, 19.6%, 11.6% and 8.4% respectively. Conclusion The prevalence of oral yeast carrier among the examined clinical patients is characterized by high isolation rate, and there are different resistance rates to the five tested antifungal drugs.Especially, there is a high resistance rate to azole drugs.
Objective To investigate the distribution of oral yeasts and their drug sensitivity in hospitalized patients from emergency department for clinical prevention of fungal infection and rational use of drugs. Methods Oral examination and microbial swabs were obtained from hospitalized patients from emergency department of Hainan Province from 2015 to 2016.In order to reveal the prevalence of yeast colonization by isolation and cultivation of fungi, and to detect its susceptibility to amphotericin B, fluconazole, ketoconazole, itraconazole and flucytosine. Results Among the 352 oral swabs, 241(68.8%)tested positive to contain yeasts, and 8 carried more than 2 strains. The prevalence of yeast colonization was significant higher among those over 60 years old compared with their younger counterparts(P<0.05). 250 strains of yeast belong to 10 species were isolated from the oral cavity of 241 inpatients, including 134 strains of Candida albicans, 61 strains of Candida glabrata,28 strains of Candida tropicalis, 13 strains of Candida krusei, and 14 other strains. The antifungal drugs susceptibility analysis found that the resistance rate to amphotericin B, fluconazole, itraconazole, ketoconazole and flucytosine were 2%,20.4%, 19.6%, 11.6% and 8.4% respectively. Conclusion The prevalence of oral yeast carrier among the examined clinical patients is characterized by high isolation rate, and there are different resistance rates to the five tested antifungal drugs.Especially, there is a high resistance rate to azole drugs.
引文
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[15]Asmundsdottir L R,Erlendsdottir H,Gottfredsson M.Nationwide study of candidemia,antifungal use,and antifungal drug resistance in Iceland,2000 to 2011[J].J Clin Microbiol.2013;51:841–848.
[16]Pfaller M A,Messer S A,Woosley L N,et al.Echinocandin and triazole antifungal susceptibility profiles for clinical opportunistic yeast and mold isolates collected from 2010 to 2011:application of new CLSI clinical breakpoints and epidemiological cutoff values for characterization of geographic and temporal trends of antifungal resistance[J].J Clin Microbiol.2013,51:2571–2581.
[17]Bonfietti L X,Szeszs M W,Chang M R,et al.Ten-year study of species distribution and antifungal susceptibilities of Candida bloodstream isolates at a Brazilian tertiary hospital[J].Mycopathologia.2012;174:389–396.
[18]Fan X,Xiao M,Liao K,et al.Notable Increasing Trend in Azole Non-susceptible Candida tropicalis Causing Invasive Candidiasis in China(August 2009 to July 2014):Molecular Epidemiology and Clinical Azole Consumption[J].Front Microbiol.2017,8:464.
[2]Thean Y T,Li Y H,Marissa M A,et al.Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region[J].Medical Mycology.2016,54(5)471-477.
[3]沈娟,杨海燕,周芸等.2011-2015年神经外科患者下呼吸道感染病原菌分布及耐药性分析[J].国外医药抗生素分册.2017,38(1):9-13.
[4]Achkar J M,Fries B C.Candida infections of the genitourinary tract[J].Clin Microbiol Rev.2010,23(2):253-273.
[5]Xu J.,Mitchell T.G,Vilgalys R.PCR-restriction fragment length polymorphism(RFLP)analyses reveal both extensive clonality and local genetic differences in Candida albicans[J].Mol Ecol.1999,8(1):59-73.
[6]Wang H,Xu J,Guo H,Wu J,Yi G,Pei H,Niu L,Li Y.Patterns of human oral yeast species distribution on Hainan Island in China[J].Mycopathologia.2013;176:359–68.
[7]Wu J,Guo H,Yi G,et al.Prevalent drug resistance among oral yeasts from asymptomatic patients in Hainan,China[J].Mycopathologia.2014,177(5-6):299-307.
[8]Teo J Q,Candra S R,Lee S J,et al.Candidemia in a major regional tertiary referral hospital–epidemiology,practice patterns and outcomes[J].Antimicrob Resist Infect Control.2017,6:27-42.
[9]Khadka S,Sherchand J B,Pokhrel B M,et al.Isolation,speciation and antifungal susceptibility testing of Candida isolates from various clinical specimens at a tertiary care hospital,Nepal[J].BMC Res Notes.2017,10(1):218-223.
[10]Mushi M F,Bader O,Taverne-Ghadwal L,et al.Oral candidiasis among African human immunodeficiency virus-infected individuals:10 years ofsystematic review and meta-analysis from subSaharan Africa[J].J Oral Microbiol.2017,9(1):1317579.
[11]Xisto M I,Caramalho R D,Rocha D A,et al.Pan-azole-resistant Candida tropicalis carrying homozygous erg11 mutations at position K143R:a new emerging superbug?J Antimicrob Chemother[J].2017,72(4):988-992.
[12]Juliana M M A,Luis A S R,Fillipe O P,et al.Prevalence of Candida tropicalis and Candida krusei in onychomycosis in Jo a軇o Pessoa,Paraiba,Brazil from 1999 to 2010[J].Annals of the Brazilian Academy of Sciences.2015,87(3):1819-1822.
[13]Pfaller M A,Moet G J,Meser S A,et al.Candida bloodstream infections:comparison of species distributions and antifungal resistance patterns in community-onset and nosocomial isolates in the SENTRY Antimicrobial Surveillance Program,2008–2009[J].Antimicrob Agents Chemother.2011,55:561–566.
[14]Lockhart S R,Iqbal N,Cleveland A A,et al.Species identification and antifungal susceptibilitytesting of Candida bloodstream isolates from population-based surveillance studies in two U.S.cities from,2008 to 2011[J].J Clin Microbiol.2012,50:3435–4342.
[15]Asmundsdottir L R,Erlendsdottir H,Gottfredsson M.Nationwide study of candidemia,antifungal use,and antifungal drug resistance in Iceland,2000 to 2011[J].J Clin Microbiol.2013;51:841–848.
[16]Pfaller M A,Messer S A,Woosley L N,et al.Echinocandin and triazole antifungal susceptibility profiles for clinical opportunistic yeast and mold isolates collected from 2010 to 2011:application of new CLSI clinical breakpoints and epidemiological cutoff values for characterization of geographic and temporal trends of antifungal resistance[J].J Clin Microbiol.2013,51:2571–2581.
[17]Bonfietti L X,Szeszs M W,Chang M R,et al.Ten-year study of species distribution and antifungal susceptibilities of Candida bloodstream isolates at a Brazilian tertiary hospital[J].Mycopathologia.2012;174:389–396.
[18]Fan X,Xiao M,Liao K,et al.Notable Increasing Trend in Azole Non-susceptible Candida tropicalis Causing Invasive Candidiasis in China(August 2009 to July 2014):Molecular Epidemiology and Clinical Azole Consumption[J].Front Microbiol.2017,8:464.