上海市热带念珠菌临床分离株耐药性及多位点序列分型研究  

Investigation of drug resistance and multilocus sequence typing for differentiation of strains of Candida tropicalis of Shanghai

作　　者：陈智瑾[1] 曹宇硕 宰淑蓓[1] 胡芸文[1] 朱召芹[1] Chen Zhijin;Cao Yushuo;Zai Shubei;Hu Yunwen;Zhu Zhaoqin(Department of Clinical Laboratory,Shanghai Public Health Clinical Center,Shanghai 201508,China)

机构地区：[1]上海市公共卫生临床中心医学检验科,201508

出　　处：《中华预防医学杂志》2018年第9期932-935,共4页Chinese Journal of Preventive Medicine

基　　金：上海市（复旦附属）公共卫生临床中心院内课题启动基金（2015-11）

摘　　要：目的 分析上海市感染性疾病患者的热带念珠菌临床分离株耐药性,并对其进行分子特征研究.方法 于2012—2015年,从上海市公共卫生临床中心87例感染性疾病患者的真菌培养标本中分离热带念珠菌,共95株;同时,收集患者的临床基本资料.采用ATB FUNGUS 3药物敏感性检测板条分析菌株对抗真菌药物的耐药性,采用多位点序列分型法（MLST）对其进行分型,同时应用MEGA 5.2软件中UPGMA方法对95株热带念珠菌进行同源性分析.结果 95株热带念球菌分别来源于结核病患者（31株）、艾滋病患者（21株）、肝病患者（19株）和罕见原因感染或发热患者（24株）;对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑和伏立康唑的耐药率分别为：2.1%（2株）、0、26.3%（25株）、26.3%（25株）和26.3%（25株）,其中,唑类耐药株患者分别来源于罕见原因感染或发热患者（14株）、艾滋病患者（8株）和结核病患者（3株）.MLST分型分析显示,产生72个序列型（ST型）,其中70种为新型别;进化树分析显示,95株临床株分布为三大簇,唑类耐药株中有24株（96.0%）分布于同一簇.结论 分离的热带念珠菌主要对唑类药物耐药,MLST分型显示与其遗传背景密切相关.Objective To analyze the drug resistance of clinical isolates of Candida tropicalis in patients with infectious diseases, and preliminarily study their molecular characteristics. Methods 95 strains of Candida tropicalis were isolated from the fungal culture specimens of 87 patients with infectious diseases in Shanghai Public Health Clinical Center from 2012 to 2015. Meanwhile, basic clinical data of patients were collected. The drug resistance of the strains to fungal drugs was analyzed by ATB FUNGUS 3 drug sensitivity test strips. All strains were classified by Multilocus sequence typing（MLST）. Then, homology analysis was conducted by MEGA 5.2 software, and the evolutionary tree was mapped by using UPGMA method. Results Patients distribution of strains was rendered as following： 31 strains from TB patients, 21 strains from HIV/AIDS patients, 19 strains from patients with liver disease, and 24 strains from rare cause infection or fever patients. The drug resistance rate to five antifungal drugs commonly used in clinical （amphotericin B, 5-fluorine cytosine, fluconazole, itraconazole, voriconazole） were 2.11% （2 strains）, 0, 26.32% （25 strains）, 26.32% （25 strains）, and 26.32% （25 strains） respectively. Among the 25 azole-resistant strains： 14 strains were from rare cause infection or fever patients, 8 strains were from HIV/AIDS patients, and 3 strains were from tuberculosis patients. In MLST, 72 sequence types （ST types） were produced, 70 of which were new types. Evolutionary tree analysis showed that 95 strains of clinical strains distribute as three large clusters. 24 azole resistant strains （96.0%） were located in CLUSER Ⅰ. Conclusion The isolated Candida tropicalis were mainly resistant to azole drugs. MLST typing indicates that they was closely related to their genetic background.

关 键 词：念珠菌 热带 基因型 真菌 耐药性 多位点序列分型法 

分 类 号：R446.5[医药卫生—诊断学] R519.3[医药卫生—临床医学]