东莞地区热带念珠菌临床分离株耐药性及基因分型研究  

The study of drug resistance and gene typing of clinical isolates of Candida tropicalis in Dongguan

作　　者：李少洪[1] 郭主声[1] 张莉[1] 林偲思[1] 谢树金 冯剑波 黄亚 陈桂铃 黄晓君 黄彬[2] LI Shao-hong;GUO Zhu-sheng;ZHANG Li(De partment of Clinical Laboratories,Dong Hua Hospital,Gruangdong Dongguan 523110,China)

机构地区：[1]中山大学附属东莞东华医院微生物室,广东东莞523110 [2]中山大学附属第一医院检验医学部,广东广州510000

出　　处：《中国实验诊断学》2021年第1期81-86,共6页Chinese Journal of Laboratory Diagnosis

基　　金：国家自然科学基金(81772249);广东省东莞市科技发展一般项目(编号:201750715046011)。

摘　　要：目的分析东莞东华医院临床分离热带念珠菌的科室分布和耐药特点,并对其进行分子特征研究,为临床感染热带念珠菌精准治疗提供抗菌药物选择理论依据。方法收集2016年1月-2017年12月住院患者分离的非重复热带念珠菌共92株,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92株热带念珠菌进行同源性分析。结果 92株热带念球菌分别来自重症监护病房(30株)、神经外科(20株)、呼吸内科(16株)、肿瘤内科(8株)、血液科(8株)、内分泌科(4株)以及其他科室6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敏感率分别为:100%、100%、85.87%、56.52%和89.13%;MLST分型分析结果显示,产生92个序列型(ST型),其中72种为新型别;进化树分析显示,92株临床株分布为三大簇,唑类耐药株中有26株分布于同一簇。结论唑类药物的耐药现象比两性霉素B和5-氟胞嘧啶严重,合理精准使用抗菌药物,减少二重感染和多重耐药的发生,而MLST分型显示与其遗传背景密切相关,值得临床重视。Objective To investigate the distribution,drug resistance and molecular characteristics of the clinical isolates of Candida tropicalisin Donghua Hospital of Dongguan and to provide a theoretical basis for the selection of accurate antimicrobial drugs for the treatment of clinical Candida tropicalisinfection.Methods The clinical strains of non-repetitive tropical candida were isolated from inpatients from January 2016 to December 2017.The ATB FUNGUS 3 drug sensitivity test strips and the multilocus sequence typing(MLST)were used to analyze the fungal drugs resistance and the dominant genotypes,respectively.The homologous analysis was carried out by using the UPGMA method in MEGA5.2 software.Results 92 strains of Candida tropicalis were isolated from intensive care unit(30 strains),neurosurgery(20 strains),respiratory department(16 strains),oncology department(8 strains),hematology(8 strains),and endocrinology(4 strains),and other departments(6 strains).The sensitivity rates to 5-fluorocytosine,amphotericin B,fluconazole,itraconazole and voriconazole were 100%,100%,85.87%,56.52%and 89.13%,respectively.The MLST showed92 sequence types(ST type),of which 72 were new types.The evolutionary tree analysis showed that 92 clinical strains were distributed into three clusters.And 26 strains of the azole-resistant strains were distributed in the same cluster.Conclusion The drug resistance of azole drugs is more serious than amphotericin B and 5-fluorouracil.The rational and accurate uses of antimicrobial drugs are necessary for reducing the occurrence of dual infection and multi-drug resistance.The MLST classification shows that it is closely related to the genetic background,which is worthy of the clinical attention.

关 键 词：热带念珠菌 耐药性 药敏试验 多位点序列分型 

分 类 号：R446.5[医药卫生—诊断学]