山东省46家医院临床分离真菌的耐药性监测  

Surveillance of drug resistance of clinically isolated fungi strains from 46 hospitals in Shandong Province

作　　者：寇琳娜 张春艳 李政 纪冰[3] 满思金[4] 伊茂礼[5] 李仁哲[6] 孙铭艳[7] 朱元祺[8] 王际亮[9] 郝明巨 国承杰 李静 于文文 盖中涛 王世富 Kou Linna;Zhang Chunyan;Li Zheng;Ji Bin;Man Sijin;Yi Maoli;Li Renzhe;Sun Mingyan;Zhu Yuanqi;Wang Jiliang;Hao Mingju;Guo Chengjie;Li Jing;Yu Wenwen;Gai Zhongtao;Wang Shifu(Department of Microbiology Laboratory,Qilu Children’s Hospital of Shandong University,Jinan 250022,China;Shandong Children Microbiology Research Center,Shandong Children’s Bacterial&Fungal Drug Resistance Surveillance and Research Collaborative Network,Jinan 250022,China;Clinical Laboratory,Binzhou Medical University Hospital,Binzhou 256603,China;Clinical Laboratory,Central People’s Hospital of Tengzhou,Tengzhou 277500,China;Clinical Laboratory,Yantai Yuhuangding Hospital,Yantai 264000,China;Clinical Laboratory,Jining First People’s Hospital,Jining 272111,China;Clinical Laboratory,the Affiliated Hospital of Weifang Medical University,Weifang 261031,China;Clinical Laboratory,the Affiliated Hospital of Qingdao University,Qingdao 266555,China;Clinical Laboratory,Shengli Oilfield Central Hospital,Dongying 257034,China;Clinical Laboratory,the First Affiliated Hospital of Shandong First Medical University,Jinan 250014,China;Clinical Laboratory,Central People’s Hospital of Zibo,Zibo 255036,China)

机构地区：[1]山东大学齐鲁儿童医院临床微生物科,济南250022 [2]山东省儿童微生物组学研究中心儿童细菌&真菌耐药监测研究协作网,济南250022 [3]滨州医学院附属医院检验科,256603 [4]滕州市中心人民医院检验科,277500 [5]烟台毓璜顶医院检验科,烟台264000 [6]济宁市第一人民医院检验科,272111 [7]潍坊医学院附属医院检验科,261031 [8]青岛大学附属医院检验科,266555 [9]胜利油田中心医院检验科,东营257034 [10]山东省第一医科大学第一附属医院检验科,济南250014 [11]淄博市中心医院检验科,255036

出　　处：《中华临床感染病杂志》2021年第1期46-53,80,共9页Chinese Journal of Clinical Infectious Diseases

基　　金：国家科技重大专项(2012ZX10004206-007,2017ZX10103004-007)。

摘　　要：目的了解山东地区临床分离真菌的菌株分布以及对常用抗真菌药物的耐药性,促进抗真菌药物的合理选择。方法依托于山东省儿童细菌&真菌耐药监测研究协作网,收集2018年1月1日至12月31日山东省46所医院1030例患者的标本,剔除痰液和咽拭子标本,共1030株真菌。分析菌株来源和类型,并采用微量稀释法进行抗真菌药物敏感性试验。采用Whonet 5.6和SPSS 22.0对数据进行分析。结果所有真菌中,主要菌株为白假丝酵母菌(38.74%,399/1030)、热带假丝酵母菌(16.99%,175/1030)及近平滑假丝酵母菌(16.41%,169/1030)等。儿童患者的主要真菌为白假丝酵母菌为(52.50%,63/120)、近平滑假丝酵母菌为(12.50%,15/120)和热带假丝酵母菌(9.17%,11/120)等。成人患者的主要真菌为白假丝酵母菌(36.37%,331/910),热带假丝酵母菌为(17.03%,155/910)和近平滑假丝酵母菌(15.27%,139/910)等。主要假丝酵母菌在1至3月和8至12月的分离率远高于其他月份。白假丝酵母菌对氟康唑和伏立康唑的耐药率分别为7.14%和7.43%,对伊曲康唑的耐药率为50.44%。热带假丝酵母菌对氟康唑、伏立康唑和伊曲康唑都有较高的耐药率,分别为29.05%、23.29%和48.65%。近平滑假丝酵母菌对氟康唑、伏立康唑、伊曲康唑的敏感率分别为93.06%、93.75%、94.44%。光滑假丝酵母菌对氟康唑表现出2.33%的剂量依赖性敏感率。对244株血液真菌分析显示,非白假丝酵母菌菌血症占比为70.08%,在涵盖92.22%的病原谱中,氟康唑的敏感率为64.65%,伏立康唑的敏感率为68.88%,两性霉素B的敏感率为88.75%,量化后获得氟康唑、伏立康唑和两性霉素B临床治疗真菌菌血症的有效率分别为70.10%、74.69%和96.23%,其中热带假丝酵母菌对伏立康唑的敏感率低于氟康唑。结论主要的真菌为假丝酵母菌属,热带假丝酵母菌对唑类抗真菌药物的耐药率呈上升趋势,其他假丝酵母菌对临床常用抗真菌药物的�Objective To analyze the distribution of clinically isolated fungal strains and their resistance to common antifungal drugs in Shandong province.Methods Through the Shandong Children’s Bacterial&Fungal Drug Resistance Surveillance and Research Collaborative Network,a total of 1030 fungi were collected in 46 hospitals of Shandong province from January 1 to December 31,2018.The source and type of strains were analyzed,and antifungal drug sensitivity tests were performed by using the micro-dilution method.Whonet 5.6 and SPSS 22.0 were applied to analyze the data.Results The overall main strains were Candida albicans(38.74%,399/1030),Candida tropicalis(16.99%,175/1030)and Candida parapsilosis(16.41%,169/1030);the main fungi strains in child patients were C.albicans(52.50%,63/120),C.parapsilosis(12.50%,15/120)and C.tropicalis(9.17%,11/120);the main fungi strains in adult patients were C.albicans(36.37%,331/910),C.tropicalis(17.03%,155/910)and C.parapsilosis(15.27%,139/910).The isolation rate of main Candida strains from January to March and August to December was much higher than that of other months.The drug resistance rates of C.albicans to fluconazole and voriconazole were 7.14%and 7.43%,respectively,and the drug resistance rates to itraconazole were 50.44%.The resistance rates of C.tropicalis to fluconazole,voriconazole and itraconazole were 29.05%,23.29%and 48.65%,respectively.The sensitivity rates of C.parapsilosi to fluconazole,voriconazole and itraconazole were 93.06%,93.75%and 94.44%,respectively.Candida glabrata showed a dose-dependent sensitivity rate of 2.33%to fluconazole.Analysis of 244 blood fungi strains showed that non-candida albicans bacteremia accounted for 70.08%.In the pathogen spectrum covering 92.22%,fluconazole was sensitive to 64.65%of the pathogens,voriconazole was 68.88%,and amphotericin B was 88.75%.After quantification,the effective rates of fluconazole,voriconazole and amphotericin B in the clinical treatment of fungal bacteremia were 70.10%,74.69%and 96.23%,respectively.Among them,the

关 键 词：真菌 念珠菌病 侵袭性 耐药性监测 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]