医院和外界环境真菌筛查及药物敏感性分析  

Hospital and external environmental fungal screening and drug susceptibility analysis

作　　者：刘瑞广 郭建[2] LIU Ruiguang;GUO Jian(Department of Clinical Laboratory,Guiyang First People's Hospital,Guiyang 550001,Guizhou,China;Department of Clinical Laboratory,Shanghai East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]贵阳市第一人民医院检验科,贵州贵阳550001 [2]上海市东方医院南院检验科,上海200120

出　　处：《检验医学》2024年第12期1150-1156,共7页Laboratory Medicine

摘　　要：目的通过培养组学调查医院、牧场、湖泊、湿地和海洋环境真菌分布情况及其耐药特征,为人类和动物真菌感染的诊疗提供参考。方法采集医院、牧场、湖泊、湿地和海洋的环境样本612个,通过真菌培养组学方法,用沙保弱葡萄糖琼脂培养基、科玛嘉念珠菌显色培养基和泛真菌培养基对不同环境来源的样本进行培养。采用基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)对培养分离的真菌进行种属鉴定,并对临床不常分离的真菌进行真核生物核糖体RNA基因内部转录间隔区(ITS)测序分析。采用微量肉汤稀释法进行真菌药物敏感性试验。结果612个环境样本中共分离到327株真菌,分布于72个不同种属。酵母样真菌中分离率最高的是克柔念珠菌(11.01%,36/327),其次为热带念珠菌(8.26%,27/327)。丝状真菌分离率由高到低依次为烟曲霉7.65%(25/327)、黑曲霉6.12%(20/327)、黄曲霉2.75%(9/327)。目前临床比较关注的酵母样真菌耳念珠菌、皱褶念珠菌、解脂念珠菌和链状念珠菌、璞膜念珠菌均有检出。环境中分离的热带念珠菌对泊沙康唑(66.67%)、伏立康唑(57.90%)、氟康唑(52.63%)的耐药率较高,对棘白菌素类药物的耐药率均为29.62%;璞膜念珠菌对伏立康唑、米卡芬净的耐药率分别为33.33%和66.67%。结论不同环境真菌的分布存在差异,且环境菌株具有一定的耐药性。酵母样真菌中克柔念珠菌分离率最高,临床关注的部分酵母样真菌也有检出。丝状真菌中曲霉属分离率较高。应该注意真菌病的预防研究不限于医院环境。Objective To investigate the distribution and drug resistance characteristics of fungi in the external environments of hospitals,pastures,lakes,wetlands and oceans by culture omics,so as to provide a reference for the diagnosis and treatment of fungal infections in animals and humans.Methods Samples were collected from different environments,such as hospitals,pastures,lakes,wetlands and oceans.Based on the fungal culture omics,Sabouraud dextrose agar,CHROM Agar Candida and pan-fungal medium were used to culture the samples from different environments.The cultured fungi were identified by matrix-assisted laser desorption ionization timeof-flight mass spectrometry(MALDI-TOF MS),and the fungi that were rarely isolated in clinic were confirmed by internal transcribed spacer(ITS)sequencing analysis.Microbroth dilution method was used to determine fungal susceptibility.Results From 612 samples of different environments,327 isolates of fungi were isolated by co-culture,distributed in 72 different species.The highest isolation rate of yeast-like fungi was Candida krusei(11.01%,36/327),followed by Candida tropicalis(8.26%,27/327).The filamentous fungi were followed by Aspergillus fumigatus(7.65%,25/327),Aspergillus niger(6.12%,20/327)and Aspergillus flavus(2.75%,9/327).The yeast-like fungi,which were concerned in the diagnosis and treatment of clinical fungal infections,were also isolated,and these included Candida auris,Candida rugosa,Candida lipolytica Candida catenulata and Candida membranaefaciens.The resistance rates of Candida tropicalis to posaconazole(66.67%),voriconazole(57.90%),fluconazole(52.63%)were high,and the resistance rate to echinocinins was 29.62%.The resistance rates of Candida membranaefaciens to voriconazole and micafungin were 33.33%and 66.67%,respectively.Conclusions There are differences in the distribution of fungi in different environments,and the environmentalisolates have certain drug resistance.Among the yeast-like fungi,the isolation rate of Candida krusei is the highest,and partial yeast-li

关 键 词：真菌 环境 克柔念珠菌 链状念珠菌 质谱鉴定 

分 类 号：R446.1[医药卫生—诊断学]