深部真菌的临床分布与耐药分析  

Clinical distribution and drug resistance analysis of deep fungus

作　　者：程绍云[1] 刘泽涛[1] 王海燕[1] 赵巍[2] 

机构地区：[1]青岛市第三人民医院检验科,266041 [2]青岛大学医学院微生物教研室,266021

出　　处：《中华临床实验室管理电子杂志》2015年第4期230-233,共4页Chinese Journal of Clinical Laboratory Management(Electronic Edition）

基　　金：山东省自然科学基金资助项目(2R2010CM011)

摘　　要：目的分析掌握本院临床分离出的深部真菌菌群分布及耐药情况,为临床合理应用抗念珠菌药物提供依据。方法回顾性分析青岛市第三人民医院2012至2014年9 875例门诊和住院的感染患者各种临床标本中,经常规培养分离出真菌后,用VITEK-2全自动微生物分析仪鉴定到种;用丹麦Rosco抗真菌药敏纸片扩散法进行药敏试验,以确定其耐药性。结果从9 875份标本中分离出6种237株深部真菌,各类标本的真菌培养阳性率为2.4%(237/9 875份);以白色假丝念珠菌和热带假丝念珠菌为主,分别占70.9%(168/237株)、19.8%(47/237株);其余为近平滑假丝念珠菌[2.1%(5/237株)]、葡萄牙假丝念珠菌[1.3%(3/237株)]、光滑假丝念珠菌[2.5%(6/237株)]、曲霉[3.4%(8/237株)];2012至2014年深部真菌培养检出阳性率分别为1.9%(54/2 798株)、2.4%(76/3 127株)、2.7%(107/3 950株),分别占阳性标本的6.9%(54/781株)、8.1%(76/933株)、8.6%(107/1248株),真菌培养检出阳性率有逐年上升趋势。其中白色假丝念珠菌和热带假丝念珠菌对氟康唑、伊曲康唑、酮康唑耐药率较高,分别为16.1%(27/168株)、14.3%(24/168株)、14.9%(25/168株)和12.8%(6/47株)、19.1%(9/47株)、17.0%(8/47株)。结论临床深部真菌的检出率有逐年上升趋势,以白色假丝念珠菌和热带假丝念珠菌为主,二者对氟康唑、伊曲康唑、酮康唑均具有较高的耐药率,应引起临床关注。Objective To analyze retrospectively flora distribution and drug resistance of deep fungus in three years of clinical isolatsed provides reasonable grounds for clinical rational utilization. Methods 9 875 clinical samples of infected patients from outpatients and hospital wards had been retrospectively analyzed during 2012-2014 in the Third People′s Hospital of Qigndao. After conventionally being cultured and isolated, fungi were identified by VITEK-2 automatic microorganism analyzer. Drug susceptibility test was performed by the Danish Rosco antifungal susceptibility disk diffusion method to ascertain tolerance of fungi. Results Six species and 237 strains of deep fungus were isolated from 9 875 clinical samples, in which the positive rate of every type candida culture was 2.4%（237/9 875）. The major components of 237 deep fungus were Candida albicans and Candida tropicalis, accounted for 70.9%（168/237）, 19.8%（47/237） respectively; the rest were Candida parapsilosis 2.1%（5/237）, Candida lusitaniae 1.3%（3/237）, Candida glabrata 2.5%（6/237） and aspergillus 3.4%（8/237）. The positive rate of each reminder was 1.9%（54/2 798）, 2.4%（76/3 127） and 2.7%（107/3 950）, accounting for 6.9%（54/781）, 8.1%（76/933） and 8.6%（107/1 248） of the entire positive samples. Moreover, the percentage of fungus culture positive samples had the tendency to increase year by year. Candida albicans and Candida tropicalis possess high resistance towards Fluconazole, Itraconazole, and Ketoconazole（Candida albicans were 16.1%（27/168）, 14.3%（24/168）, 14.9%（25/168）; Candida tropicalis were 12.8%（6/47）,19.1%（9/47）, 17.0%（8/47）. Conclusions In the separation and identification of clinical specimens, deep candida detection rate increases year by year. The most isolates are Candida albicans and Candida tropicalis, with have high resistance to fluconazole, itraconazole, and ketoconazole, which need clinical attention.

关 键 词：念珠菌 耐药率 药敏试验 

分 类 号：R446.5[医药卫生—诊断学]