苏州某三甲医院念珠菌菌血症调查及耐药性分析  

Investigation and drug resistance analysis of candidemia in a tertiary hospital in Suzhou

作　　者：管湘玉 朱云凤 王敏[1] 郑毅[1] 谢小芳[1] 吕晶南 杜鸿[1] Guan Xiang-yu;Zhu Yun-feng;Wang Min;Zheng Yi;Xie Xiao-fang;LüJing-nan;Du Hong(Department of Clinical Laboratory,the Second Affiliated Hospital of Soochow University,Suzhou 215004;Zhangjiagang TCM Hospital Affiliated to Nanjing University,Zhangjiagang 215600)

机构地区：[1]苏州大学附属第二医院,苏州215004 [2]南京中医药大学附属张家港市中医医院,张家港215600

出　　处：《中国抗生素杂志》2022年第3期304-308,共5页Chinese Journal of Antibiotics

基　　金：苏州市临床微生物学重点实验室项目(No.SZS201715);苏州市科技计划民生科技项目(No.SLT201934);张家港市科技计划项目(No.ZKS1834)。

摘　　要：目的 分析念珠菌菌血症流行病学特征及耐药情况。方法 收集2015年1月—2019年12月念珠菌菌血症中分离的65株菌,通过显色法和质谱仪鉴定,采用微量肉汤稀释法分别测定棘白菌素、5-氟胞嘧啶、两性霉素、氟康唑、伏立康唑和伊曲康唑MIC值并采用单中心回顾性方法收集患者的临床资料,进行Fisher精确检验和卡方检验。结果 本研究中白念珠菌和光滑念珠菌总体分离率分别为47.7%和26.2%。伊曲康唑的总体耐药率最高为15.9%,热带念珠菌联合耐药率高为50%(P<0.001)。有无静脉置管与念珠菌血症预后有关(P=0.018)。结论 念珠菌菌血症中白念珠菌为常见菌,光滑念珠菌在念珠菌菌血症中比例较高。伊曲康唑对血液念珠菌耐药率高,热带念珠菌易产生唑类联合耐药。临床经验性用药应结合地区念珠菌流行病学特征。Objective To investigate epidemiological characteristics and drug resistance in candidemia.Methods A total of 65 strains of Candida from candidemia were collected from January 2015 to December 2019.The Candida species were identified by chromogenic plate and MALDI-TOF. The micro broth dilution method was used to determine the MIC values of echinocandin, 5-FC, AMB, FCA, ITR, VRC, and AMB. The single-center retrospective method was used to collect clinical data of patients who were infected by candidemia. Finally, tests were performed using Fisher exact test or the Chi-squared test. Results The most common Candida species during the study period were C. albicans(47.7%) and C. glabrata(26.2%). Itraconazole had the highest resistance rate(15.9%), and C. tropicalis had a high resistance rate of 50% to multi-drugs(P<0.001). Presence of CVC was the only independent predictor of prognosis in candidemia(P=0.018). Conclusion C. albicans had the highest frequency in candidemia. The proportion of C. glabrata in candidemia was increased. The Candida spp. in candidemia had a high rate of resistance to ITR. C. tropicalis was susceptible to azole resistance. Clinical empirical medication should be combined with the epidemiological characteristics of Candida in the region.

关 键 词：念珠菌菌血症 流行病学 耐药 

分 类 号：R978.1[医药卫生—药品]